Do your legs always feel heavy? Do they hurt? Maybe this is Chronic Venous Insufficiency (CVI)!

Do you sometimes feel like your legs are as heavy as a rock? Do you feel more and more pain when you stand or walk? Are your legs swollen and brown in places? These are not just random things. The reason for this may be that the veins in your legs, which are the veins that carry dirty blood to the heart, are not working properly. Today we are talking about this condition, which is Chronic Venous Insufficiency (CVI) . Don't worry, let's understand this simply.

What is CVI? Simply put...

Chronic venous insufficiency, or CVI, is a disease of the veins in your legs that is caused by damage to the veins. Think about it, the veins in our legs are the ones that carry used blood back to the heart. Inside these veins are small valves, like doors. These only let blood flow in one direction, that is, upwards, towards the heart. In CVI, these valves are damaged. Then the blood starts to pool in the legs instead of flowing upwards properly. This increases the pressure inside the veins.

CVI can be caused by damage to any of the veins in your legs. These include:

• Deep veins: These are the large veins that run deep inside your body, between your muscles.
• Superficial veins: These are veins that are close to the skin, just beneath the skin.
• Perforating veins: These are the small bridge-like veins that connect the deep and superficial veins.

Although CVI may initially cause only minor symptoms, over time this condition can affect your daily life and cause serious complications.

What is the difference between CVI and post-thrombotic syndrome?

Now you may be wondering, is this CVI or 'post-thrombotic syndrome' two different things? In fact, both of these refer to the same problem of damaged veins in the legs. However, 'post-thrombotic syndrome' refers to CVI caused by a blood clot in a deep vein (Deep Vein Thrombosis - DVT). 'Post-thrombotic' means after a blood clot (also called a 'thrombus') has formed. After this blood clot has broken down, the veins in that area may be damaged and scar tissue may remain.

Post-thrombotic syndrome develops in between 20% and 50% of people who have a DVT, usually within a year or two.

How common is CVI?

Venous disease is very common. For example, varicose veins affect about one in three adults. Each year, about one in 50 people with varicose veins will develop CVI.

CVI usually occurs more often in people over the age of 50. This risk increases with age.

Overall, CVI affects about one in 20 adults.

What happens to the body with CVI?

Chronic venous insufficiency (CVI) slows the flow of blood from your legs to your heart. If left untreated, CVI can cause the pressure inside your leg veins to build up so much that even the smallest blood vessels (capillaries) in your body can burst. When this happens, the skin in that area turns a reddish-brown color, and it can be easily bruised by a minor cut or bruise.

These burst capillaries can cause the following things:

• Tissue inflammation in that area.
• Tissue damage .
• Venous stasis ulcers . These are wounds that form on the surface of the skin and take a long time to heal.

These venous ulcers do not heal easily and can become infected. If the infection spreads to the surrounding tissue, it is called cellulitis . This can be dangerous if not treated quickly.

What are the symptoms of CVI?

Symptoms of chronic venous insufficiency (CVI) may include:

• Feeling of pain or fatigue in the legs: Feeling of heaviness and pain in the legs, as if you have been tired all day and cannot move them.
• Burning, numbness, or a "pins and needles" feeling in the legs.
• Cramping of the legs at night.
• Skin discoloration: Appears as a reddish-brown color.
• Swelling of the legs and ankles (Edema): This can be seen especially after standing for a long time or at the end of the day. It's like your legs swelling after getting off a crowded bus.
• Dry, flaky, or itchy skin on the legs or feet.
• Feeling of fullness and heaviness in the legs.
• The skin on the legs looks rough and leathery.
• Ulcers: These usually occur on the ankles. If these ulcers are very painful, they may be infected.
• Varicose veins: Veins that bulge and appear twisted above the surface of the skin.

If you have severe edema in your groin area, scar tissue can form. This scar tissue causes fluid to build up inside your tissue. Your groin can become larger and feel firm to the touch. When this happens, your skin is more likely to break.

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

What are the stages of CVI?

Venous disease is classified into stages 0 to 6. "Venous disease" is a general term for many problems that can occur in your veins, including CVI. These stages are classified based on what a doctor sees (clinical signs) when he or she examines your legs.

Here are the stages of venous disease:

• Stage 0: There are no visible signs, but you may experience symptoms such as leg pain and fatigue.
• Stage 1: Visible blood vessels, spider veins, and spider veins can be seen.
• Stage 2: Varicose veins are more than 3 millimeters wide.
• Stage 3: There is swelling (edema), but no skin changes.
• Stage 4: There are changes in skin color and/or texture.
• Stage 5: There is a healed wound.
• Stage 6: There is an active (unhealed) wound.

Your doctor will tell you that you have chronic venous insufficiency (CVI) if you are stage 3 or higher. This means that just because you have varicose veins doesn't mean you have CVI. But varicose veins are a sign of a problem with blood flow, and they can get worse over time. So, if you notice a new varicose vein, it's important to tell your doctor about it.

What are the causes of CVI?

Chronic venous insufficiency (CVI) occurs when the valves inside your leg veins don't work properly. As I mentioned earlier, these valves help keep blood flowing in one direction (towards the heart). If one of these valves is damaged, it doesn't close properly. Gravity makes it difficult for blood to flow upward. Instead, the blood starts to flow backward. This is called venous reflux .

The reasons why valves do not work properly can be congenital, primary, or secondary.

• Congenital causes: These are defects in the veins in your legs that you are born with. For example, some people are born without valves in their leg veins.
• Primary causes: These are any changes in the way the veins in your legs work that prevent them from working properly. For example, one of your veins may be too wide and its valve may not close completely.
• Secondary causes: These are the damage to the veins in your legs caused by other diseases. Deep Vein Thrombosis (DVT) is the main cause. After the blood clot (thrombus) breaks down, scar tissue remains in that area, damaging the valves.

What is the main cause of CVI?

A deep vein thrombosis (DVT) is the main cause of chronic venous insufficiency (CVI). This blood clot damages the valves in the veins in your legs. People with a history of DVT are at higher risk of developing CVI.

How do I find a doctor for CVI?

Chronic venous insufficiency (CVI) is diagnosed through a physical examination and an ultrasound. During the physical examination, the doctor will:

• Your legs will be examined carefully: The doctor will look for signs of CVI, such as wounds and skin discoloration.
• Vascular ultrasound: This is a painless test that uses sound waves to take pictures of your veins. This can help determine which parts of your veins are damaged.

The doctor will also check for other conditions that could be causing your symptoms. This may include other tests, such as an MRI.

Many people with CVI also have a condition called Peripheral Artery Disease (PAD) . So, your doctor may ask questions and do tests to find out if you have PAD. If you have both CVI and PAD, your doctor will advise you on treatment options and precautions to take when using compression therapy .

What are the treatments for CVI?

Lifestyle changes and compression therapy are the main treatments for chronic venous insufficiency (CVI). If these are not enough, your doctor may recommend a procedure or surgery. The best treatment for you will depend on how advanced your condition is and what other medical conditions you have. Your doctor will tailor your treatment plan to your needs.

The goals of treatment are:

• Helping to improve blood circulation in your veins.
• Helping to heal wounds and reduce their recurrence.
• Improving the appearance of your skin.
• Reducing pain and swelling.

Lifestyle changes

Typically, doctors recommend lifestyle changes as the first line of treatment for CVI. These include:

• Leg elevation: Elevating your legs above the level of your heart can help reduce pressure in the veins in your legs. Your doctor may tell you to do this at least three times a day for 30 minutes or more.
• Exercise: Walking and other exercises can improve blood circulation in the veins of your legs. Every time you take a step, your calf muscles contract and help the veins pump blood back to your heart. This "calf muscle pump" is also called your "second heart." It is what moves blood up your legs against gravity, which is very important for your blood circulation. So, strengthening your calf muscles can improve your blood circulation. Your doctor may also recommend exercises that stretch and bend your legs and ankles.
• Weight management: Being overweight can put pressure on your veins and damage your valves. Ask your doctor what a healthy weight is for you. Work with your doctor to develop a healthy and manageable plan to get to that weight.

Compression therapy

Doctors often recommend compression therapy to treat CVI. Compression therapy helps reduce swelling and discomfort in your legs.

There are different types of compression stockings and socks. Some are tighter than others. Very tight stockings require a prescription from a doctor. Some stockings are "graduated," meaning they increase in tightness at the ankle and decrease in tightness as you move up the leg. It's important to follow your doctor's instructions about what type of compression you need and when to use it.

Many people with CVI have difficulty wearing compression stockings for long periods of time. But compression therapy is very important to keep your veins working properly and reduce your symptoms. If you have difficulty with compression therapy, talk to your doctor. You may need a different type of stocking. Or, your doctor may be able to give you advice that can make your treatment plan a little easier.

If socks don't help, your doctor may suggest a method called intermittent pneumatic compression (IPC) . IPC devices are like inflatable sleeves that you wear on your legs. These help keep blood flowing through your veins.

People with peripheral arterial disease (PAD) should be very careful with compression therapy. Depending on the severity of your PAD, your doctor may tell you not to use it at all. Follow your doctor's instructions exactly.

Medications

The medications used to treat CVI are:

• Antibiotics: Treat skin infections or wounds caused by CVI. These medications do not treat the underlying disease.
• Anticoagulants (blood thinners): Treat blood clots and prevent future clots.
• Unna boot : This bandage is a fairly tight bandage made with multiple layers of compression and a wound dressing containing zinc oxide gel.

Nonsurgical treatment

Non-surgical treatments for CVI include:

• Sclerotherapy: Your doctor injects a foam or liquid solution into your spider veins or varicose veins. This causes the vein to shrink and disappear.
• Endovenous thermal ablation: This method targets large veins. It uses either laser beams or high-frequency radio waves to create intense heat. This heat seals off the diseased vein, but because it is located within the body, there is very little bleeding or bruising.

Surgical treatment

The surgical options for CVI are:

• Ligation and stripping: These two procedures are often done together. In vein ligation, the doctor cuts and ties off the problematic veins. Stripping is the surgical removal of a large vein through two small incisions.
• Microincision/ambulatory phlebectomy: This is a minimally invasive procedure. It targets varicose veins that are just above the skin’s surface. The doctor makes small incisions or punctures in your veins with a needle. Then, a phlebectomy hook is used to remove the problematic veins.
• Subfascial Endoscopic Perforator Surgery (SEPS): This is also a minimally invasive procedure. It targets the perforating veins above your ankle. The doctor uses a clip to close the damaged veins so that they don't bleed. SEPS helps the wounds heal and also helps prevent them from forming again.
• Vein bypass: This is similar to heart bypass surgery, but it's done in a different location. Your doctor takes a healthy vein from another part of your body and uses it to create a new path for blood to flow around the damaged vein. Doctors only use this procedure in very severe cases, when all other treatments have failed.

Who is at higher risk of developing CVI?

If you have risk factors for CVI, you are more likely to develop the disease than others. The risk factors are:

• Having a history of deep vein thrombosis (DVT) (this is the most important thing).
• Varicose veins or a family history of varicose veins.
• Obesity.
• Pregnancy.
• Not getting enough physical activity.
• Smoking and tobacco use.
• Sitting or standing for long periods of time (e.g. teachers, shop assistants, security guards, etc.).
• Sleeping in a chair or armchair.
• May-Thurner syndrome.
• Being a woman.
• Being over 50 years of age.

Can CVI be prevented?

Sometimes CVI can't be prevented. But you can reduce your risk of developing CVI and other vascular problems by making some lifestyle changes. These include:

• Avoid smoking and tobacco use.
• Avoid wearing tight clothing, which means wearing tight girdles or belts.
• Don't sit or stand for long periods of time. Get up and move around as often as possible.
• Eat a heart-healthy diet. This includes reducing your salt (sodium) intake.
• Exercise regularly .
• Maintain a healthy weight.

If you have developed DVT, your doctor may prescribe blood thinners (anticoagulants).

What happens to someone with CVI?

CVI is not usually life-threatening or life-threatening. However, it is a progressive disease that can cause discomfort, pain, and a decrease in enjoyment of life. Treatment can help control your symptoms and improve your quality of life.

Venous ulcers are difficult to heal and can recur even with treatment. It is very important to go to all your doctor's appointments and follow your doctor's instructions exactly.

Can CVI be completely cured?

Treatments can't reverse the damage to your vein valves. But you can reduce your symptoms and live a better quality of life. Some procedures and surgeries can target and remove damaged veins so that blood doesn't flow through them.

Also, chronic venous insufficiency (CVI) cannot be completely cured. But you can manage the condition with lifestyle changes and other treatments recommended by your doctor.

How does someone with CVI take care of themselves?

Your doctor will tell you how to manage CVI at home. Here are some general tips:

• Don't stand or sit for long periods of time. On long car rides or plane rides, flex and extend your legs, feet, and ankles about 10 times every 30 minutes. This helps the blood flow through the veins in your legs. If you have to stand for long periods of time, take frequent breaks and sit down with your legs elevated.
• Check your skin. Check your skin every time you shower. If you notice any changes, such as new sores, call your doctor.
• Keep your legs elevated. When sitting or lying down, keep your legs above the level of your heart.
• Exercise regularly . Walking is especially good for the veins in your legs.
• Control your weight. Maintain a healthy weight for you. Talk to your doctor about what that weight is.
• Maintain good skin hygiene. Wash your skin every day and apply moisturizer. Ask your doctor what moisturizer is best for your skin. Keeping your skin moisturized can help prevent it from drying out, cracking, and becoming infected. Your doctor may also recommend creams to reduce itching, protect your skin, or prevent fungal infections.
• Wear compression stockings if your doctor recommends them. This is one of the best ways to manage CVI. There are different types, so follow your doctor's instructions on which type is best for you. Also, ask your doctor how to wash and care for your stockings.

When should I see the doctor?

If you have risk factors for chronic venous insufficiency (CVI), see your doctor. Your doctor can assess your risk factors and help you reduce them.

If you have CVI, go to all your doctor's appointments and follow the doctor's instructions about when to come back.

Call the doctor at this time:

• If you have any questions about your situation.
• If you have new symptoms or your symptoms change.
• If your compression stockings are not tight enough, they should not be wrinkled or crumpled. Elastic stockings that are not tight enough can make your condition worse, as they can restrict blood flow through the wrinkled area.

When to go to emergency care

If you have symptoms of a pulmonary embolism, call your local emergency number immediately. This is a life-threatening complication of deep vein thrombosis (DVT). It requires immediate medical attention.

What questions should you ask the doctor?

There is a lot to learn about chronic venous insufficiency (CVI). Don't hesitate to ask your doctor any questions you have. You may also want to ask these questions:

• What stage of chronic venous insufficiency (CVI) am I in?
• How can I manage CVI at home?
• How can you help me continue with compression therapy?
• Do I need a procedure or surgery?
• What can I do to prevent my CVI condition from getting worse?

Finally, things to remember

Vein problems are often more than just a cosmetic issue. Chronic venous insufficiency (CVI) worsens over time, and it can have a major impact on your quality of life.

If you've been suffering from varicose veins for a while, you may be feeling frustrated and wishing it would go away sooner. Fortunately, there are many things you can do on your own to manage your symptoms and stay healthy. But it's important to stick to the plan. Talk to your doctor about strategies to maintain a daily treatment plan and make compression therapy something you can do. You're not alone, and don't be afraid to ask for help.

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