Have you visited the doctor with painful, swollen or cramped legs recently? If so, then you may have been diagnosed with a condition known as Chronic Venous Insufficiency (CVI). CVI is a common disease that affects around 1 in 20 adults, with numbers typically increasing as we age.
Those who are most at risk from the disease are people who:
- Are over 50
- Spend prolonged periods lying, standing or sitting down
- Are clinically obese or highly overweight
- Are pregnant, or
- Have a family history of the disease.
So what exactly is venous insufficiency, and how is it caused?
Chronic venous insufficiency is a painful medical condition that affects the lower limbs - primarily the legs. It occurs when a vein valve that carries the blood around the body malfunctions, causing the blood to flow back into the leg and away from the heart.
To explain more about what happens, we need to understand how a normal vein valve works.
Essentially, a vein contains a valve with a two-way flap. These flaps are made of elastic tissue, and their primary role is to keep the blood flowing in one direction. When we move our legs, the muscles squeeze or contract the vein, pushing the two-way valve towards the open position. Once open, blood flows freely in one direction from the leg up towards the heart.
When we stop moving, the valve closes, and the muscle rests. A functioning closed valve prevents gravity from taking hold and stops blood from flowing backwards and collecting (pooling) in the legs.
Unfortunately, when the two-way vein valve malfunctions, pooling is a natural result.
Pooling can trigger a whole host of uncomfortable symptoms, including aching, cramping, swollen legs and skin changes.
The skin of the legs can also feel itchy, and ulcerations may develop. If left, leg ulcers can be hard to treat and quickly become infected, so it’s best to see a doctor as soon as you see a problem.
So what are the signs and symptoms of chronic venous insufficiency?
Symptoms of CVI can manifest in one or more conditions and include:
- Tired or achy legs
- ‘Pins and needles’ sensations in the leg area
- Burning, tingling or cramping of the lower limb
- Discolored skin that appears reddish brown
- Swelling in the lower leg or ankle - known as an edema
- Itchy or flaking skin on the legs or feet
- Skin that appears leathery
- Heavy feeling in the legs
- Ulcers (open sores) typically near the ankle
- Varicose veins
So, if you have one or more of these symptoms, does it mean you have CVI?
You see, venous disorders (of which CVI is one) can be classified into stages, ranging from no physical symptoms to active leg ulcerations. Therefore, milder conditions don’t automatically mean you are predisposed to having venous insufficiency.
Let’s take a look.
Stages of venous disorders
Venous disorders can be classified in stages ranging from 0-6. These stages are based on tell-tale clinical signs that your doctor will notice when examining the leg.
These stages are as follows:
Stage 0 – No visible signs are present, but the legs may begin to feel achy or tired
Stage 1 – Blood vessels or capillary veins may be visible through the skin – spider veins
Stage 2 – Visible varicose veins at least 3mm wide
Stage 3 – Signs of swelling in the lower limb but no physical skin changes
Stage 4 – Material changes to your skin’s texture or color.
Stage 5 – Signs of healed ulcerations
Stage 6 – An acute (active skin ulcer
If you show signs and symptoms of stage 3 and above, you will likely be diagnosed with venous insufficiency.
Alternatively, If you present with stage 2 symptoms of varicose veins, it doesn’t mean you have CVI. However, varicose veins indicate blood flow problems within the lower limbs that can worsen over time. Therefore, it’s vital to monitor any further changes and tell your doctor if you see any changes in your current condition.
Treating Chronic Venous Insufficiency
In the first instance, CVI is a treatable condition involving lifestyle changes and compression therapy. If these measures don’t work, your care provider may recommend non-surgical or surgical options.
Treatments include lifestyle changes such as
- Leg elevation
- Exercise (walking)
- Weight management (if applicable)
Compression therapy can also be used in the form of compression bandages or stockings. Some healthcare providers may also recommend intermittent pneumatic compression (IPC) devices. These consist of inflatable sleeves worn over the leg to allow better blood flow through the veins.
In conjunction with the above, antibiotic and anticoagulant medications can also treat skin infections caused by CVI or blood clots.
Alternatively, patients can opt for non-surgical therapy, including ground-breaking techniques like sclerotherapy or endovenous thermal ablation (ETA).
Here at MINT, for example, Dr Akinwande provides sclerotherapy and ETA treatments that utilize either radiofrequency or a medicating foam to eradicate a problem vein. Once the problem vein has shrunk or been reabsorbed, the blood naturally re-routes itself via trouble-free veins.
The final option is to undergo surgery, including techniques like ligation and vein stripping or artery bypass surgery. These surgeries are designed to either remove the vein altogether or bypass it.
Unfortunately, chronic venous insufficiency cannot always be prevented. However, there are steps you can take to lower the risk.
How to prevent CVI?
Making simple lifestyle changes can lower the risk of getting CVI. Changes include:
- Avoiding smoking
- Avoid sitting or standing for too long – Experts recommend taking breaks of 5-15 minutes out of every hour
- Eat a healthy diet lower in sodium
- Take regular exercise
- Maintain a healthy weight
If your care provider does feel that lifestyle changes are needed, they will give you the tools and support necessary to get the ball rolling.
Non-surgical treatment for CVI at MINT
If you have been diagnosed with venous insufficiency and lifestyle changes or compression gear doesn’t seem to work, talk to the team at the Midwest Institute for Non-Surgical Therapy (MINT).
Dr Akinwande is a board-certified vascular and endovascular specialist who uses the latest non-surgical techniques to fix vein issues like CVI.
For further information about these techniques or to schedule an appointment, get in touch at 314-255-2204 or make a booking online.
We have 5 convenient locations for patients to choose from in MO and IL, including our latest addition in Chicago IL.
Photo from Freepiks