Are your legs swollen and your veins knotted? This could be Chronic Venous Insufficiency (CVI)

Do you also have swollen legs in the evening after standing all day? Do your legs just feel heavy and achy? Maybe the skin on your legs has turned brown and your veins are visible? Although you may think these things are simple fatigue, they may be a sign of a medical condition that needs some attention. Today we are talking about such a condition, Chronic Venous Insufficiency, or CVI for short.

Simply put, what is CVI?

Think of the veins in our bodies as one-way streets. The biggest challenge for veins, especially those in the legs, is to move blood back up toward the heart, against gravity. To help with this task, our veins have small gate-like structures inside them. In medicine, we call these 'valves.' These valves stop the blood from flowing back down when it goes up.

Chronic Venous Insufficiency (CVI) is a condition where the veins in your legs become damaged and the valves that I mentioned don't work properly. This causes blood to pool in your legs instead of going up. We call this venous reflux . When blood pools like this, the pressure inside the veins increases. Over time, this is what we call CVI.

This damage can happen to any type of vein in your leg:

• Deep veins: These are the large veins that run deep inside the body, between the muscles.
• Superficial veins: These are located close to the skin, just below the surface.
• Perforating veins: These veins connect the two types of veins mentioned above.

Although it may initially start with minor symptoms, over time, CVI can interfere with your daily life and cause serious complications.

Are CVI and post-thrombotic syndrome the same thing?

Both names refer to the same problem, which is damage to the veins in the legs. But there is a slight difference. Post-thrombotic syndrome is a condition of CVI caused by a blood clot in a deep vein in the leg (Deep Vein Thrombosis - DVT). After the clot dislodges, a fine scar is left in the vein wall where it was, which can damage the valve. Post-thrombotic syndrome is likely to develop in 20% to 50% of people who have had a DVT within a year or two.

How common is CVI and how does it affect my body?

Venous disease is actually quite common. For example, about one in three adults has varicose veins . Of these people, about one in 50 will develop CVI each year.

CVI usually affects people over the age of 50. The risk increases with age. Overall, about one in 20 adults has CVI.

When blood flow to the legs is blocked due to CVI, the pressure inside the veins increases dramatically. If left untreated, this high pressure can cause the tiny blood vessels (capillaries) in our body to burst. The skin in that area turns a reddish-brown color . Also, the skin can be easily injured by even the slightest abrasion.

These ruptured blood vessels can cause:

• Tissue inflammation in that area
• Tissue damage
• Venous stasis ulcers (these are wounds that form on the surface of the skin and do not heal easily)

These types of ulcers do not heal easily, and they can become infected with germs. If this infection spreads to the surrounding tissues, we call it cellulitis . This can be a dangerous condition if not treated quickly.

What are the symptoms of CVI?

You don't have to have all of these symptoms at once. You might only have one or two. These symptoms depend on how advanced your condition is.

What are the stages of CVI?

Doctors classify vascular disease into stages 0 to 6. CVI is one of these. Your doctor will determine the stage based on what he or she sees when examining you.

• Stage 0: There are no visible symptoms, but you may experience symptoms such as leg pain and fatigue.
• Stage 1: Spider veins appear.
• Stage 2: Appearance of varicose veins more than 3 mm wide.
• Stage 3: There is swelling (edema) in the legs, but no skin changes.
• Stage 4: Changes in skin color and texture (e.g., browning) begin.
• Stage 5: An ulcer has formed and a scar has formed after it heals.
• Stage 6: Presence of an active, unhealed ulcer.

What are the main causes of CVI?

As I mentioned before, the main cause of CVI is the valves in the veins in the legs not working properly. There are several reasons why these valves can become damaged.

• Congenital causes: Some people may be born without or with weak valves in their veins.
• Primary causes: Without any specific cause, the walls of the veins become weak, the veins become dilated, and the valves may not close properly.
• Secondary causes: Damage to the veins due to another medical condition. The main and most common cause of this is deep vein thrombosis (DVT) . The blood clot damages the valves.

How does a doctor diagnose this?

When you go to see a doctor, the first thing he does is examine your legs carefully. He looks for things like swelling, changes in skin color, and wounds.

Then, a Vascular Ultrasound test is performed to more accurately diagnose the disease. This uses sound waves to create an image of your veins on a computer screen. This can help you see exactly which veins are damaged and where. This is a painless, simple test.

What are the treatments for CVI?

There are a few main goals of treatment for CVI:

• Improving blood circulation in the legs.
• Helping wounds heal and preventing recurrence.
• Improving the appearance of the skin.
• Reducing pain and swelling.

Treatment methods can be divided into several main parts.

1. Lifestyle Changes

This is the first and most important step in treatment.

• Elevating your legs: Elevate your legs above your heart for about 30 minutes, about three times a day. This will reduce pressure on your veins.
• Exercise: Walking is great. When you walk, the calf muscles help to pump blood up the veins. This is also called a "second heart."
• Weight management: As your body weight increases, more pressure is placed on your veins. It is very important to maintain a healthy weight for your height.

2. Compression Therapy

This is a very important part of CVI treatment. It involves wearing specially designed, tight stockings (compression stockings). These stockings apply pressure to the outside of the legs, helping to reduce blood pooling and moving it upward.

3. Medications

• Antibiotics: If skin wounds become infected with bacteria, they are given to heal them.
• Anticoagulants: These are recommended if you have a condition like DVT or are at risk.
• Unna boot: This is a special bandage with a medicinal gel applied to it. It helps wounds heal while also providing pressure to the leg.

4. Non-surgical treatments and surgery

If lifestyle changes and compression therapy do not control the condition, the doctor may consider other treatments.

How can CVI be prevented?

Sometimes this condition cannot be completely prevented. But there are some things you can do to reduce your risk:

• Avoid smoking.
• Don't stay in the same position (standing or sitting) for long periods of time. Change positions frequently and walk around a bit.
• Maintain a healthy weight.
• Exercise regularly.
• Reduce salt intake and eat a heart-healthy diet.

When should you see a doctor?

If you have symptoms of CVI or risk factors, be sure to see a doctor. Especially,

• If your symptoms are new or worsening.
• If the compression stockings prescribed for you do not fit properly (they should not be wrinkled, as this can further restrict blood flow).

Vein problems are sometimes more than just a cosmetic issue. CVI is a progressive disease that can affect your quality of life. Therefore, by getting the right medical advice and following the treatment exactly, you can control this condition well and live a comfortable life.

CVI, Chronic Venous Insufficiency, Leg Swelling, Varicose Veins, Venous Ulcer, Leg Pain