Understanding Chronic Venous Insufficiency
Chronic venous insufficiency or CVI is a medical condition where the veins cannot pump enough oxygen-poor blood back to the heart. As a result skin changes start to develop in the lower part of the leg. It starts with recurring bouts of itch and excema and progresses to the development of permanent skin changes.
What causes it?
When you stand upright, the blood in your leg veins must travel against gravity to return to your heart. To accomplish this, your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. Valves in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump. When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and increase the venous blood pressure. If you suffer from varicose veins
What are the symptoms?
The most common symptom is swelling of the ankles. Your legs may also feel heavy, tired, restless, or achy particular after periods of prolonged standing or at the end of the day.
Skin changes such as excema or permanent discolouration may develop, and signify that harmful changes are happening in the skin. A significant proportion of patients progress to develop venous ulceration.
- Compression stockings. Useful when symptoms are mild, where there are few varicose veins to treat or after deep venous thrombosis.
- Thermal Ablation or Foam Sclerotherapy. Best for patients wishing to avoid an operation. The majority of sufferers are best treated with one of these options.
- Surgery. Usually reserved for the small number of patients who can't be managed by a key-hole procedure.
A detailed history, clinical examination and ultrasound assessment will be preformed to identify the underlying cause of your symptoms. In some cases, referral to a vascular radiologist for more intensive investigation of either the arterial circulation or deep veins may be required. Leg ulceration is a very common problem, causes significant suffering and requires intensive and prolonged dressing regimens to treat. Appropriate assessment and treatment by an experienced vascular surgeon can greatly improve healing of leg ulcers and reduce the risk of them recurring in the future.