Chronic venous insufficiency
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|Chronic venous insufficiency|
Mild chronic venous insufficiency
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|NCI||Chronic venous insufficiency|
|Patient UK||Chronic venous insufficiency|
Chronic venous insufficiency or CVI is a medical condition where the veins cannot pump enough blood back to the heart. The commonest cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as edema and ulceration, it is referred to as chronic venous disease. CVI includes varicose veins and superficial venous reflux ("hidden varicose veins") It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.
Most people with CVI can be improved with treatments to the superficial venous system or stenting the deep system. Varicose veins for example can now be treated by local anaesthetic endovenous surgery.
Signs and symptoms
Signs and symptoms of CVI in the leg include the following:
- Varicose veins
- Itching (pruritus)
- Phlebetic lymphedema
- Chronic swelling of the legs and ankles
- Venous ulceration
CVI in the leg may cause the following:
- Venous stasis
- Stasis dermatitis, also known as varicose eczema
- Contact dermatitis. Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis.
- Atrophie blanche. This is an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias. It is a late sequelae of lipodermatosclerosis where the skin has lost its nutrient blood flow.
- Lipodermatosclerosis. This is an indurated plaque in the medial malleolus.
- Malignancy. Malignant degeneration is a rare but important complication of venous disease since tumors which develop in the setting of an ulcer tend to be more aggressive.
- Pain. Pain is a feature of venous disease often overlooked and commonly undertreated.
- Skin thickening
CVI in the leg may be caused by the following:
- Blood clots in the deep veins. This is called Deep vein thrombosis, or DVT. CVI caused by DVT may be described as postthrombotic syndrome
- Arteriovenous fistula (an abnormal connection or passageway between an artery and a vein).
- May-Thurner syndrome. This is a rare condition in which blood clots occur in the iliofemoral vein due to compression of the blood vessels in the leg. The specific problem is compression of the left common iliac vein by the overlying right common iliac artery.
An alternative explanation has shown Chronic venous insufficiency as the result of venous valves incompetence instead and/or obstacles to the flow (see)
Surgical treatment of CVI attempts a cure by physically changing the veins with incompetent valves. Surgical treatments include:
- Linton procedures (an older treatment)
- Ligation. Tying off a vein to prevent blood flow
- Vein stripping. Removal of the vein.
- Surgical repair.
- Endovenous Laser Ablation
- Vein transplant.
- Subfascial endoscopic perforator surgery. Tying off the vein with an endoscope.
- Valve repair (experimental)
- Valve transposition (experimental)
- Hemodynamic surgeries.
Treatment of CVI in the leg involves managing the symptoms (and preventing the symptoms getting worse) instead of effecting a cure. It is sometimes called conservative treatment. Conservative treatments include:
- Manual compression lymphatic massage therapy
- Skin lubrication
- Sequential compression pump
- Ankle pump
- Compression stockings
- Blood pressure medicine,
- Frequent periods of rest elevating the legs above the heart level
- Tilting the bed so that the feet are above the heart. This may be achieved by using a 20 cm (7-inch) bed wedge or sleeping in a 6 degree Trendelenburg position. Obese or pregnant patients might be advised by their physicians to forgo the tilted bed.
- "Chronic Venous Insufficiency". Society for Vascular Surgery. December 1, 2009.
- Whiteley MS (2011). "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers". Whiteley Publishing. Retrieved January 8, 2015.
- RT Eberhardt, JD Raffetto (2005). "Contemporary Reviews in Cardiovascular Medicine - Chronic Venous Insufficiency. Circulation. 2005 111: 2398-2409 doi: 10.1161/01.CIR.0000164199.72440.08". Circulation. Retrieved January 8, 2015.
- Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. (1999). "Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study.J Epidemiol Community Health. 1999 Mar;53(3):149-53.". J Epidemiol Community Health. Retrieved January 8, 2015.
- Robertson LA, Evans CJ, Lee AJ, Allan PL, Ruckley CV, Fowkes FG. (May 2014). "Incidence and risk factors for venous reflux in the general population: Edinburgh Vein Study. Eur J Vasc Endovasc Surg. 2014 Aug;48(2):208-14. doi: 10.1016/j.ejvs.2014.05.017. Epub 2014 Jun 18.". Eur J Vasc Endovasc Surg. Retrieved January 8, 2015.
-  Ann Vasc Surg. 2007 Sep;21(5):652-62. Dermatologic complications of chronic venous disease: medical management and beyond. Barron GS1, Jacob SE, Kirsner RS. PMID 17823046