Understanding Chronic Venous Insufficiency: Insights from Experts

Chronic venous insufficiency (CVI) affects up to 40% of adults in the United States, hindering proper blood flow in the legs. This condition occurs when the valves in the veins fail to function, resulting in blood pooling in the lower extremities. Dr. Miguel F. Manzur, a vascular surgeon at the USC Cardiac and Vascular Institute, part of Keck Medicine of USC, provides crucial insights into the symptoms, diagnosis, treatment, and prevention of CVI.

What is Chronic Venous Insufficiency?

CVI is characterized by the malfunction of the leg veins, where the valves progressively weaken over time. As a result, blood struggles to return to the heart, leading to symptoms such as leg swelling, heaviness, tiredness, varicose veins, skin discoloration, and in severe cases, ulceration. Among these, the most common complaint is swelling in the legs, which can significantly impact daily activities.

Identifying Risk Factors and Diagnosis

The risk of developing chronic venous insufficiency increases significantly with age, particularly for individuals over 50. Women are more susceptible due to factors such as pregnancy, which increases blood volume and alters hormonal balances, affecting vein health. Genetics play a notable role as well; individuals with family histories of vein problems, particularly among female relatives, are at higher risk. Additional contributing factors include obesity, sedentary lifestyles, and previous instances of deep vein thrombosis (DVT), where blood clots form in deep veins, often in the legs or pelvis.

Diagnosing CVI involves a thorough evaluation by a healthcare professional. It begins with a physical examination where a doctor assesses the leg’s appearance for signs such as spider veins, varicose veins, swelling, or discoloration. A venous reflux ultrasound may then be conducted to evaluate valve functionality. This non-invasive test helps determine if blood is flowing backward, indicating potential valve damage.

Management and Treatment Options

Treatment for chronic venous insufficiency varies depending on the severity of symptoms. Many patients experience mild discomfort and can manage their condition through lifestyle changes. Increased physical activity, particularly walking, is encouraged, as it aids in promoting blood circulation. Health professionals often advise against prolonged periods of sitting or standing, as this can exacerbate symptoms.

Weight management and leg elevation are also beneficial for reducing swelling. For many, wearing compression stockings is a first-line treatment, providing support to the veins and promoting better blood flow.

For those with more serious manifestations of CVI, such as skin discoloration known as lipodermatosclerosis or painful ulcerations, specialized care becomes essential. Proper wound care is critical to prevent infections and promote healing. In such cases, doctors may collaborate with primary care providers to adjust medications or introduce treatments like topical steroids for skin irritations.

When conservative measures fail to alleviate symptoms, more invasive interventions may be necessary. Options include venous ablation, a minimally invasive procedure to remove damaged veins, typically performed in a doctor’s office in approximately 20–30 minutes. Other procedures, such as stenting or phlebectomy, may also be considered based on individual patient needs.

Long-term Outlook and Travel Considerations

While treatments can significantly improve symptoms and offer long-lasting relief, chronic venous insufficiency is a recurrent condition. Patients may need ongoing monitoring and communication with vein specialists to manage potential flare-ups or new vein issues.

Travel can pose additional challenges for individuals with CVI, particularly during long periods of sitting, such as on flights or car journeys. Dr. Manzur recommends wearing compression socks during travel. Passengers should attempt to elevate their legs when possible and take breaks every hour to walk around, promoting circulation. Simple calf pumps while seated can also help keep blood flowing.

Chronic venous insufficiency may be a common issue, but understanding its implications, recognizing symptoms, and seeking timely treatment can make a significant difference in managing this condition effectively.