Chronic Venous Insufficiency (CVI)

CVI occurs when the one-way valves in leg veins that prevent blood from flowing backward become damaged, allowing blood to pool in the veins (venous reflux).

Primary Causes:

• History of deep vein thrombosis (DVT)
• Varicose veins
• Venous valve abnormalities
• Prolonged standing/sitting
• Multiple pregnancies
• Obesity

Common Symptoms:

• Leg swelling (edema), especially after standing
• Aching, tired, or heavy feeling in legs
• Leg cramps or throbbing pain
• Itching or tingling sensations
• Worsening pain when standing
• Relief when elevating legs

Advanced Symptoms:

• Skin changes (discoloration, thickening)
• Flaking or itchy skin (venous eczema)
• Leg ulcers (typically near ankles)
• Superficial thrombophlebitis
• Lipodermatosclerosis (hardened skin)

Risk Factors

• Age over 50
• Family history of venous disease
• Female gender (hormonal factors)
• Sedentary lifestyle
• Occupations requiring prolonged standing
• Smoking
• History of leg trauma

Diagnostic Methods

• Duplex ultrasound (primary diagnostic tool)
• Venography (in complex cases)
• CT or MR venography
• Physical examination with visual inspection
• Clinical severity scoring (CEAP classification)

Treatment Options

Conservative Treatments:

• Compression therapy (stockings, wraps)
• Leg elevation protocols
• Exercise programs
• Weight management
• Skin care regimens

Medical Therapies:

• Phlebotonic medications (for symptom relief)
• Topical steroids (for dermatitis)
• Antibiotics (for infected ulcers)

Minimally Invasive Procedures:

• Endovenous thermal ablation (laser/RF)
• Sclerotherapy (liquid or foam)
• Mechanical ablation (MOCA)
• Cyanoacrylate closure (VenaSeal)

Surgical Options:

• Vein stripping/ligation
• Ambulatory phlebectomy
• Valve repair/reconstruction
• Bypass procedures (for severe cases)

Daily Management Strategies

• Wear prescribed compression stockings daily
• Elevate legs above heart level regularly
• Engage in walking and calf muscle exercises
• Maintain healthy weight
• Avoid prolonged sitting/standing

Preventing Progression

• Early treatment of varicose veins
• Prompt management of DVT
• Regular vascular check-ups if at risk
• Smoking cessation
• Blood pressure control

When to Seek Immediate Care

• Sudden severe leg swelling
• Signs of skin infection (redness, warmth, fever)
• Non-healing ulcers
• Bleeding from varicose veins

With proper treatment and lifestyle adjustments, most patients with CVI can achieve significant symptom relief and prevent serious complications like venous ulcers.