chronic venous insufficiency

chronic venous insufficiency (CVI), condition in which the veins in the legs no longer efficiently return blood to the heart, causing blood to pool in the lower extremities. Chronic venous insufficiency (CVI) occurs when one-way valves in veins that lie deep beneath the surface of the skin become damaged or weakened or when blood flow between the limbs and the heart is obstructed, such as in deep vein thrombosis (formation of a blood clot in a deep vein, commonly in the legs). Normally, one-way valves in veins keep blood moving upward, in the direction of the heart, preventing its backflow to the legs.

Risk factors and symptoms

Risk factors for CVI include aging, smoking, prior blood clots, family history of cardiovascular disease, obesity, physical inactivity, and varicose veins. Menopause and pregnancy are additional risk factors in women. CVI commonly causes edema (swelling) of the legs, aching in the legs, and a feeling of heaviness or fatigue, especially after long periods of standing or sitting. Skin in the affected area may develop brownish discoloration, caused by deposition of the iron-rich pigment hemosiderin, and the skin may become itchy or thicker as the disease progresses. Varicose veins also become increasingly visible, and venous ulcers—open sores that often are near the ankles and slow to heal—may develop. Left untreated, these ulcers can become infected.

Diagnosis and treatment

CVI is diagnosed based on symptoms, physical examination, and imaging tests. Duplex ultrasound, a noninvasive imaging technique that combines two-dimensional grayscale imaging (B-mode) and Doppler to measure the speed and direction of blood flow, is commonly used to assess vein structure and function. Other imaging techniques may also be employed to help identify blockages or pooling, including magnetic resonance venography, which relies on a contrast dye and magnetic fields to produce detailed images of the veins, and venography, an invasive procedure that uses a contrast agent injected via a catheter, followed by X-ray imaging.

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Treatment of CVI focuses on improving circulation and preventing complications. Lifestyle changes, such as regular exercise, leg elevation, and weight management, can reduce symptoms. Compression stockings, which typically are tighter at the ankle and looser farther up the leg, can help improve blood flow and reduce swelling. In advanced cases, medical procedures such as sclerotherapy, endovenous ablation, or surgical vein removal may be necessary to improve blood flow. Because CVI is incurable, ongoing care is necessary to maintain leg and cardiovascular health.