Chronic venous insufficiency treatment guidelines

What is chronic venous insufficiency (CVI)?

Chronic venous insufficiency (CVI) is a condition in which the venous wall and/or valves in the leg veins do not function properly, making blood flow back to the heart more difficult. Blood “pools” or collects in these veins as a result of CVI, and this pooling is known as stasis.

What causes chronic venous insufficiency in the first place?

All of the body’s organs send blood to the heart through veins. Blood must circulate upward from the veins in the legs to enter the heart. Each move requires the calf and foot muscles to contract in order to compress the veins and force the blood upward. One-way valves in the veins hold the blood flowing up and not back down.

When these valves become disabled, blood leaks backward, causing chronic venous insufficiency. Valve damage may be caused by aging, sitting or standing for long periods of time, or a combination of aging and decreased mobility. Blood pressure in the veins remains high for long periods of time when the veins and valves are compromised to the point that blood flow up to the heart is difficult.

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CVI is most often caused by a blood clot in the legs’ deep veins, a condition known as deep vein thrombosis (DVT). CVI can also be caused by pelvic tumors and vascular malformations, and it can also happen for no apparent reason. Swollen legs occur when the valves in leg veins fail to retain blood against gravity, resulting in slow blood flow out of the veins.

Post-thrombotic syndrome refers to chronic venous insufficiency that occurs as a result of DVT. Within ten years of being diagnosed with DVT, up to 30% of people will develop this problem.

What are the signs and symptoms of venous insufficiency?

As the disease progresses, the severity of CVI, as well as the complexities of treatment, increases. That’s why, if you’re experiencing any of the symptoms of CVI, you should see your doctor right away. Waiting will not make the issue go away, and the sooner it is handled and treated, the better the chances of avoiding severe complications. Symptoms include:

  • Swelling in the lower legs and ankles, especially after standing for long periods of time
  • Legs that ache or are tired
  • Varicose veins that have appeared recently
  • Legs with a leathery appearance
  • Legs or feet with flaking or itchy skin
  • Ulcers of stasis (or venous stasis ulcers)


Who is affected by chronic venous insufficiency?

CVI affects about 40% of people in the United States. It is more common in people over the age of 50, and it affects women more than men.

How is CVI diagnosed?

A full medical history and physical exam will be performed by your doctor to diagnose CVI. During the physical examination, the doctor will inspect the legs thoroughly. The blood supply in your legs can be examined using a vascular or duplex ultrasound examination. A transducer (small hand-held device) is mounted on the skin over the vein to be examined during vascular ultrasound. Sound waves are emitted by the transducer and bounce off the vein. These sound waves are captured, and a picture of the ship is produced and shown on a monitor.

What are the options for treating or managing chronic venous insufficiency?

CVI, like any illness, is best treated in its early stages. For people with CVI, vascular medicine or vascular surgery experts usually prescribe a combination of treatments. The following are some of the most basic care strategies:

  • Avoid long periods of standing or sitting: If you must take a long trip and will be sitting for a long period of time, flex and stretch your legs, feet, and ankles about 10 times every 30 minutes to keep the blood circulating in the leg veins. Take regular breaks to sit down and elevate your feet if you must stand for long periods of time.
  • Exercise on a daily basis. Walking is particularly good for you.
  • If you are overweight, you can lose weight.
  • Elevate your legs when sitting or lying down, so that they are higher than your heart.
  • Compression stockings should be worn.
  • To treat skin infections, take antibiotics as needed.
  • Maintain proper skin hygiene.

The treatment’s aims are to minimize blood pooling and avoid leg ulcers.

Nonsurgical Treatment

Sclerotherapy and endovenous thermal ablation are two nonsurgical options.

Sclerotherapy is a procedure that involves injecting a solution into spider veins or small varicose veins, causing them to collapse and disappear. To achieve the desired results, several sclerotherapy treatments are typically needed. Sclerotherapy is a simple, low-cost procedure that can be done in the doctor’s office. Sclerotherapy can relieve the pain and irritation of these veins while also reducing the risk of complications including venous hemorrhage and ulceration. It’s often often done for aesthetic reasons.

Endovenous thermal ablation is a newer technique that creates extreme local heat in the affected vein using a laser or high-frequency radio waves. – Energy source has its own technology, but both types of local heat close in on the target vessel. This procedure seals the problem veins thus leaving them in place, resulting in minimal bleeding and bruising. Endovenous thermal ablation, as opposed to ligation and stripping, causes less discomfort and allows for a quicker return to daily activities while maintaining similar cosmetic outcomes.



Chronic venous insufficiency treatment guidelines

Chronic venous insufficiency treatment guidelines

University Hospital