Chronic venous insufficiency (CVI) describes a condition affecting the veins in the lower extremities (legs) with venous hypertension. This leads to a pain, swelling, edema, skin changes, and ulcerations in the legs.
Chronic venous insufficiency is also called "venous reflux". Venous reflux occurs when venous valves don't function adequately, leading to reversal of blood flow through the valves during standing or sitting.
Venous reflux most commonly occurs when vein valves weaken due to genetic influences or multiple pregnancies, among other factors.
When the valves in the veins of the lower body do not properly channel blood flow back to the heart, because of blockage or venous valve malfunction, blood flow slows, pressure increases and swelling occurs in the legs and feet.
Venous reflux is often self-perpetuating, as the pooling of blood in veins distends them, which pulls apart the valve leaflets of the next, lower valve and causes reflux farther down the leg.
As blood pools in lower extremities, veins further swell, leading to pain, pigmentation of the skin and clots in the varicose veins (phlebitis). The high venous pressure in some cases can lead to nonhealing of simple breaks in the skin, which is seen as a chronic skin ulcer, usually around the ankle.
CVI is caused by long-term blood pressure that is higher than normal inside the leg veins. Phlebitis and deep vein thrombosis might lead to CVI.
Factors that can increase the risk of CVI include:
- Family history of varicose veins
- Being overweight
- Being pregnant
- Not enough exercise
- Standing or sitting for long periods of time
- Women over 50 years old have a higher risk of developing CVI
The symptoms of chronic venous insufficiency are:
- Persistent swelling of the lower legs
- Leg pain, dull aching, heaviness or cramping.
- Bluish discoloration of the skin at the ankles.
- With prolonged swelling, venous ulcers can develop at the ankles and these often become infected (Fig. 2).
In simple cases, treatment for venous reflux can range from making lifestyle changes to use of compression stockings. In more complex cases, surgery may be required to correct the venous reflux and halt the progression of disease in the leg.
Treatment of ulcers associated with venous requires a special dressing saturated with medication to promote healing. The dressing is applied from toes to knee and wrapped securely with an elastic bandage. Bed rest with leg elevation is also required to achieve healing.
When an ulcer persists despite treatment, surgical removal of the ulcer may be necessary, or veins connecting to the ulcer may have to be tied off to reduce swelling and pressure in the area. Lifelong wearing of elastic compression stockings is absolutely required for a varicose ulcer to remain healed.
Traditionally, one of the most common surgical procedures has been vein stripping, in which a vein-stripping tool is pulled through the great saphenous vein, removing the vein from the leg. More recently, vein stripping has largely been replaced by other vein ablation techniques.
Minimally Invasive Approaches
UCSF vascular surgeons have extensive experience with the latest minimally invasive approaches for treatment of venous disease. One is using radiofrequency (RF) vein ablation, a technique in which a catheter delivers microwave radiation to seal veins that have reflux.
Radiofrequency ablation allows clinicians to eliminate venous reflux with a needle puncture that is covered with a band-iid versus traditional procedures that require two painful incisions. Patients undergoing RF ablation are able to return to work in days instead of weeks using this technique.