Chronic Venous Insufficiency
What is it?
Chronic venous insufficiency (CVI) is a condition where blood pools in the veins of the lower legs.
Who gets it?
People who are obese, extremely inactive, or elderly may develop chronic venous insufficiency because all three factors can lead to problems with the valves in the veins. However, this condition can also be inherited.
What causes it?
The veins return blood to the heart from all the body’s organs. To reach the heart, the blood needs to flow upward from the veins in the legs. To do this, the calf muscles and the muscles in the feet need to contract with each step to squeeze the veins and push the blood upward. To keep the blood flowing up, and not back down, the veins contain one-way valves. Chronic venous insufficiency occurs when these valves become damaged, allowing the blood to leak backward. Varicose veins can damage the valves. Or, damage can occur when there is a problem with the calf muscle, so the blood isn’t being pushed upward. Chronic venous insufficiency can also be caused by a blockage in a vein, such as a blood clot. When any of these conditions occur, the blood can pool (called stasis) in the veins.
What are the symptoms?
The first signs of chronic venous insufficiency are ankle and leg swelling. Swelling occurs because the blood that has pooled in the veins causes abnormally high pressure in the veins. As the pressure and swelling increases, the skin of the legs may actually leak tiny drops of plasma, which is the pale yellow fluid part of blood. Eventually, the capillaries burst under the high pressure, releasing red blood cells and giving that area of the skin a reddish-brown discoloration. The discolored skin is easily broken by a scratch or bump. When this happens, the patient frequently develops leg ulcers, called venous stasis ulcers, which can become infected. An infected skin ulcer will ooze pus and have a foul-smelling discharge. If the infection spreads to the surrounding tissue, the patient develops a condition called cellulitis. Other symptoms of chronic venous insufficiency include legs that ache, feel heavy, or feel tired, especially after long periods of standing; new varicose veins; leg skin that looks and feels leathery; and flaking and itching in the affected area of the legs.
How is it diagnosed?
To diagnose chronic venous insufficiency, your doctor will take your medical history and carefully examine your
legs. He or she may use a procedure called duplex scanning, which is a painless ultrasound examination of the leg veins.
What is the treatment?
Treatment for chronic venous insufficiency usually includes compression stockings, which squeeze the veins and keep blood flowing so it is more difficult for blood clots to form. If the skin is not broken or leaking fluid, your doctor may recommend an anti-itch cream, such as one containing hydrocortisone; a cream containing zinc oxide to protect the skin; or an antifungus cream to prevent fungal infections. Skin that is leaking fluid is treated with wet compresses. If you have ulcers on your legs, your doctor will show you how to apply layered compression bandages to protect the skin and maintain blood flow. Infected ulcers and cellulitis must be treated with antibiotics.
Self-care tips
If you have been diagnosed with chronic venous insufficiency, you can help the pooled blood to drain by elevating your feet whenever you are sitting or lying down. Your feet should be raised above the level of your heart. Avoid any long periods of sitting or standing. If you must take a long trip, 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 wear elastic stockings, be sure to take them off each day to wash and dry them, and to clean and check your skin and give it some air. Make sure the stockings fit so there is no bunching. Elastic stockings that fit poorly will actually make your condition worse by blocking blood flow in the area where they have bunched up. Also keep your skin moisturized so that it doesn’t flake or crack easily. Follow your doctor’s recommendations for daily exercise so it is easier to maintain a healthy weight.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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