Chronic Venous Insufficiency

CVI and VSU

Chronic Venous Insufficiency

The valves in the veins channel the flow of blood toward the heart. When these valves are damaged, blood leaks and pools in the legs and feet. Venous insufficiency is a condition in which the veins fail to return blood efficiently to the heart. This condition usually involves one or more veins. Symptoms include swelling of the legs and pain in the extremities such as a dull aching, heaviness, or cramping. Venous insufficiency can be caused by a number of disorders of the veins, particularly deep vein thrombosis (blood clots) or varicose veins.

Venous Stasis Ulcerations

A venous skin ulcer, also called a stasis leg ulcer, is a shallow wound that develops when the leg veins do not move blood back toward the heart normally. Venous skin ulcers typically develop on either side of the lower leg, above the ankle and below the calf.

Causes

The veins in the body have valves that keep blood flowing toward the heart. In a condition called venous insufficiency, the valves are damaged and allow some blood to back up in the vein. The slowed circulation causes fluid to seep out of the overfilled veins into surrounding tissues, causing tissue breakdown and ulcers. Less frequently, blocked veins are a contributing factor in the development of venous skin ulcers. In many cases of venous insufficiency, patients have both obstruction of forward flow and backward leakage of the veins.

Symptoms

Symptoms of venous insufficiency include:

  • Edema (swelling)
  • Skin discoloration
  • Prominent varicose veins or ropy veins
  • Skin ulcers (venous stasis ulcerations)
  • Aching, burning, or throbbing sensation in the legs and feet
  • Cramping
  • Leg Weakness

Medications and immobility can also affect the muscles and veins of the legs. Patients should also consider signs and symptoms of venous insufficiency before traveling or having surgery.

Risk Factors

Some of the risk factors that can contribute to venous insufficiency are:

  • Older age
  • Varicose veins
  • Previous deep vein thrombosis (blood clots)
  • Family history (other members of the family suffer from the disorder)
  • Obesity
  • Inactivity
  • Muscle weakness
  • Pregnancy
  • Injury to the legs
  • Cancer

Treatment

Improving circulation is critical in the treatment of venous skin ulcers. You can accomplish this by using a Lymphedema Pump, using specially fitted compression stockings, and elevating your legs above the level of your heart. In most cases the wound is completely healed with prior less intensive remedies. However, most patients that suffer from venous insufficiency require daily pneumatic pump therapy to prevent future ulcerations from occurring.

In The Venous Ulcer Guideline developed by the Government and Regulatory Task Force of the Association for the Advancement of Wound Care, an "A" level of evidence was assigned to eight different compression therapy options. One of the eight therapeutic modalities receiving an "A" level rating was intermittent pneumatic compression.

Lymphedema pumps have been in use since the 1960s for the treatment of limb swelling due to both acute and chronic conditions. Multi-chamber sequential compression pumps like the ones manufactured by Bio-Compression and Lympha Press typically provide the greatest programming flexibility. Newer compression pump technology such as the Lympha-Pants employs large multi-segment chambers that cover bilateral limbs and the lower or upper trunk simultaneously so that a comprehensive treatment may be delivered in a more efficient manner. The sequential inflation of chambers from distal to proximal in these devices is also thought to more naturally mimic lymph return.

Compression stockings are available in a range of prescription strengths and in different lengths (such as knee-high or thigh high stockings). Your physicians will determine the type of compression stocking that is most appropriate for your care. In some cases when a non-healing ulcer (sore) is present, a physician may prescribe special medicated wraps (such as an Unna-boot) to reduce swelling and treat the venous stasis skin ulcer.

To further help with the leg swelling caused by venous insufficiency, your doctor may also tell you to keep your legs elevated above your heart when you are lying down. He or she may also suggest that you get more exercise; for example, walking can improve your circulation. Weight loss can also be very helpful for treatment of venous insufficiency for patients who are overweight.

For patients with venous insufficiency caused by blood clots, doctors commonly prescribe anticoagulants or blood thinners. This treatment works on existing blood clots and also prevents additional clots from forming.

Prevention

Prevention of venous insufficiency is important, especially if there is a strong family history. Strategies for prevention of blood clots can help you avoid chronic venous insufficiency. Prevention methods for each patient may be different; therefore, a physician should discuss and design a personal program for each situation.

You can help prevent venous insufficiency with the following steps:

  • Maintain a healthy body weight; lose weight if you are overweight.
  • Exercise regularly.
  • If you smoke, try to quit. Smoking is harmful to the circulation.
  • Protect your legs from injury.
  • Do not stand or sit in one place or position for very long; get up and move.