Chronic Venous Insufficiency (CVI) - Causes, Diagnosis and Treatment

Chronic Venous Insufficiency (CVI): Legs Vein Valves Irregular Functioning

Veins are sophisticated blood vessels that carry blood from the body to the heart. They drain impure or deoxygenated blood from the parts of the body and transports it to the heart.

Weakness in the venous valves results in the backflow of blood and accumulation of fluid in the legs. This results in a patient developing Chronic Venous Insufficiency or CVI.

Mild cases can be treated effectively, however, long term neglect and progression of the condition can lead to the build-up of pressure which can result in swelling.

A patient experiences severe discomfort and restricted mobility of the limb(s). In advanced cases, the tiny blood vessels might burst leading to severe complications and risk of infection.

Causes Of Chronic Venous Insufficiency (CVI)

Chronic venous insufficiency is a result of malfunctioning of the venous valves in the lower legs. The weakened valves are unable to pump blood against the pull of gravity.

This leads to the blood sinking back and results in pools of blood being accumulated in the legs. Some of the most commonly known factors leading to weakness in the venous valves include:

• Pre-existing conditions or congenital defects that can lead to some patients having inherently weak venous vessels can lead to an increased risk of CVI.
• Leg Vein Thrombosis also called Phlebothrombosis, a condition where blood clots form in the vein and can increase chances of CVI.
• Inherently weak muscles in the lower legs that result in weak pressure to push the blood against gravity.
• Other factors such as stressful and physically intense activity can lead to the weakening of the blood vessel valves.
• Long term stress on the feet typically experienced by patients who spend a lot of time standing on their feet due to the nature of their work. For example, people working in the hospitality and retail industry.
• Being overweight or obese can lead to increased pressure on the legs that can lead to developing CVI.

Signs & Symptoms Of Chronic Venous Insufficiency

Some of the most commonly known symptoms associated with chronic venous insufficiency, CVI include:

• The first sign of a vascular problem like CVI is the appearance of Spider veins in the lower legs. These are clearly visible through the skin.
• There is an enlargement of these veins. Doctors often refer to these as varicose veins. Typically, these are thick protruding blood vessels which can be felt externally. The veins are often very visible through the skin.
• Increased water retention, usually starting in the feet and rising to the lower legs. This is often described as heavy legs by patients suffering from this condition.
• As the disease progresses, there is degradation in the strength of the veins that worsens over time.
• In severe cases, there is significant swelling and formation of dents in the swollen limbs when pressure is applied on the skin. These tend to subside with time.
• Patients may develop dry and itchy skin in the affected area.
• The irregular blood circulation might have unforeseen impacts like reduced healing in case of injury.

Diagnosis Of Chronic Venous Insufficiency

A complete patient history and physical examination can allow a professional medical practitioner to gather key insight into the risk factors involved and the progression of the condition.

Physicians typically follow the CEAP (Clinical Findings) Classification to distinguish different stages of progression of the disease. The 6 different stages which are highlighted with the following symptoms include:

• C 0: No visible signs of venous disease
• C 1: Spider veins, telangiectasias (enlarged blood vessels), reticular veins (reticular veins that appear bluish through the skin)
• C 2: Varicose veins with no evidence of CVI
• C 3: Varicose vein with edema (water retention)
• C 4: Varicose vein with trophic (tissue-related) skin changes
• C 5: Varicose vein with healed ulcer (ulcer)
• C 6: Varicose vein with pronounced ulcer (open leg)

It is highly recommended that patients seek medical attention at the first sign of symptoms associated with CVI. In the long term, patients are at risk of serious damage to their blood vessels, which may require surgery one day.

If the blood flow is disturbed, this always has far-reaching consequences that can affect the entire body. However, the course can be stopped or at least slowed down by early treatment and training. An early diagnosis is the best prognosis.

Treatment For Chronic Venous Insufficiency (CVI)

Treatment for CVI is mostly conservative. A physician focuses on relieving a patient’s symptoms and taking measures to slow and in some cases halt the progression of long term degeneration. Some of the most effective measures include:

Changes In Lifestyle

• It is highly recommended that patients should consider weight loss. Reducing overall body weight can reduce the stress on the lower legs and thus relieve the blood vessels.
• Making sure to take enough breaks to stretch between long hours of standing, can help stretch the muscles and provide some relief from daily strains.
• Using stairs whenever possible can be a small daily lifestyle change that can help train the leg muscles for those with a busy work life.

Rehabilitation And Physiotherapy

• Regulated physiotherapy helps with targeted muscle training is a proven effective treatment path.
• The exercises can help promote the reorganisation of the muscles and are the most effective option to curb the disease.
• Strong calf muscles helps reinforce the lower legs which support the push of blood towards the heart against the pull of gravity.

Prescribed Painkillers

In cases of inflammation in the legs, anti-inflammatory medication is also recommended to improve the patient’s symptoms. However, it can impact the patient's life in the long term.

Lymphatic Drainage Massage

Lymphatic drainage massage should be used to stimulate the surrounding area and naturally encourage drainage of lymph fluid to alleviate symptoms.

Compression Therapy

• Compression therapy is the gentle application of pressure on the affected area using medical compression stockings.
• Compression stockings like the VenoTrain range, can significantly improve a patient’s quality of life. Regular use of a compression is instrumental in preventing the progression of CVI.
• The compression helps encourage the flow of lymph fluid out of the affected legs and can greatly reduce swelling.
• They also help provide enough pressure for the blood to flow normally.

Surgical Intervention

• In cases of malformations or blockage of the blood vessels due to ruptured blood vessels after years of over-stressing, surgery is necessary. The veins are too far compromised to be treated conservatively.
• For example, doctors might use radiofrequency (RF) vein ablation, a technique in which a catheter uses microwave radiation to seal up veins that have been compromised.

Chronic Venous Insufficiency Pain Management

Medical compression stockings like the VenoTrain range are precisely tailored to the requirements of weakened veins. The supportive aid can be instrumental in both preventative and treatment paths.

The stockings help in pain relief from the moment initial symptoms of CVI manifest and can help prevent long term risks of progression.

The microfibers in the stockings help medical-grade compression on the legs and promotes healthy blood circulation through the limbs.

In the case of vein diseases that have already occurred, medical compression stockings help in avoiding complications.

Bauerfeind compression stockings are made to custom fit the patient and helps stabilise the limb and promote lymphatic drainage. Regular use of a compression stocking has proven wonders in managing the condition.