OB-GYN Associates

Chronic Venous Insufficiency Evaluation at RCI

What is chronic venous insufficiency (CVI)?

Chronic Venous insufficiency (CVI) is a condition in which the veins have problems sending blood from the legs back to the heart. The valves of the veins do not function properly, and the circulation of blood in the leg veins is impaired. This causes the veins to stay filled with blood, especially when you are standing.

CVI is a common cause of leg pain and swelling and is commonly associated with varicose veins. If chronic venous insufficiency is left untreated, pain, swelling and leg ulcers may result.

What causes chronic venous insufficiency (CVI)?

Normally when the leg muscles contract, they squeeze the deep veins of the legs, aiding in circulation. Veins contain one-way valves that keep the blood from flowing in the opposite direction, toward the foot. These valves can wear out over time, leading to blood leaking backward and pooling in the veins of the leg. Over time, the veins weaken and stretch. Blood clots, varicose veins or superficial veins that are dilated due to faulty valves can also cause CVI.

Who is affected by chronic venous insufficiency (CVI)?

An estimated 40% of people in the United States have CVI. It occurs more frequently in people over age 50, and more often in women than in men.

Risk factors include:

  • Age
  • Family history
  • Obesity
  • Hormonal changes – pregnancy, menopause, hormone therapy
  • Immobilization after surgery or injury
  • History of deep venous thrombosis blood clots in the leg veins
  • Prolonged standing

What are the symptoms of chronic venous insufficiency (CVI)?

The seriousness of CVI, along with the complexities of treatment, increase as the disease progresses. That’s why it is very important to see your doctor if you have any of the symptoms of CVI. The problem will not go away if you wait, and the earlier it is diagnosed and treated, the better your chances of preventing serious complications.

The signs and symptoms of chronic venous insufficiency (CVI) are:

  • Swelling in the legs and/or ankles (often the first sign)
  • Heavy, tight, tired, achy or restless legs
  • Varicose veins
  • Skin that becomes discolored, feels leathery, flaky and/or itchy
  • Ulcers and/or sores that won’t heal

How is chronic venous insufficiency (CVI) diagnosed?

To diagnose CVI, your doctor will perform a complete medical history and physical exam. During the physical exam, the doctor will carefully examine your legs.

The most accurate and detailed test is a vascular duplex ultrasound exam. This provides an ultrasound image of the vein so that any blockage causing blood clots or improper vein function can be detected.

Early diagnosis allows for effective treatment in most cases, and can help avoid more serious problems like venous ulcers down the road.

How is chronic venous insufficiency (CVI) treated or managed?

Like any disease, CVI is most treatable in its earliest stages. Interventional radiologists and vascular medicine or vascular surgery specialists typically recommend a combination of treatments for people with CVI. The goals of treatment are to reduce the pooling of blood and prevent leg ulcers.

Some of the basic treatment strategies include:

  • Avoiding long periods of standing or sitting. If you must take a long trip and will be sitting for a long time, flex and extend your legs, feet and ankles about 10 times every 30 minutes to keep the blood flowing in the leg veins. If you need to stand for long periods of time, take frequent breaks to sit down and elevate your feet.
  • Exercising regularly—walking is especially beneficial
  • Losing weight if you are overweight
  • Elevating your legs above the level of your heart while sitting and lying down
  • Compression therapy to relieve swelling
  • Antibiotics, if infection of the skin and underlying tissue is present
  • Practicing good skin hygiene

Compression stockings

With early diagnosis, most cases of CVI can be managed with treatments as simple as compression stockings. Compression stockings can be purchased at pharmacies and medical supply stores and come in various styles, including below-the-knee, above-the-knee and pantyhose styles.

Definitive therapies

EVLT, ambulatory phlebectomy (AP) and sclerotherapy sometimes have a role in definitive treatment. Many patients require endovascular therapies performed in the hospital, including venography, thrombolytic therapy, angioplasty and/or stent placement, and rarely, surgical interventions such as venous bypass.

All of our interventional radiologists are board certified by the American Board of Radiology with Certificates of Advanced Qualification (CAQs) in vascular and interventional radiology. They are members of the Society for Interventional Radiology (SIR).

For further information on these and other interventional radiology procedures, visit www.sirweb.org

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RCI is accredited by the American College of Radiology (ACR).

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