of or contained in or performing the function of the veins; "venous inflammation"; "venous blood as contrasted with arterial blood"; "venous circulation"
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Chronic venous insufficiency
Other names
Chronic venous disease
Mild chronic venous insufficiency, with increased pigmentation of the lower legs.
Specialty
Cardiology
Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein.[1] The most common cause of CVI is superficial venous reflux which is a treatable condition.[2] As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.
Most cases of CVI can be improved with treatments to the superficial venous system or stenting the deep system. Varicose veins for example can now be treated by local anesthetic endovenous surgery.
Rates of CVI are higher in women than in men.[3][4] The condition has been known since ancient times and Hippocrates used bandaging to treat it.
Contents
1Signs and symptoms
2Causes
3Diagnosis
3.1Classification
4Management
4.1Conservative
4.2Surgical
5See also
6References
7External links
Signs and symptoms
Chronic venous insufficiency
Signs and symptoms of CVI in the leg include the following:
Varicose veins
Itching (pruritus)
Hyperpigmentation
Phlebetic lymphedema[5]
Chronic swelling of the legs and ankles
Venous ulceration
CVI in the leg may cause the following:
Venous stasis
Ulcers.[6]
Stasis dermatitis,[6] also known as varicose eczema
Contact dermatitis.[6] Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis.
Atrophie blanche.[6] This is an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias. It represents late sequelae of lipodermatosclerosis where the skin has lost its nutrient blood flow.
Lipodermatosclerosis.[6] This is an indurated plaque in the medial malleolus.
Malignancy.[6] Malignant degeneration is a rare but important complication of venous disease since tumors which develop in the setting of an ulcer tend to be more aggressive.
Pain.[6] Pain is a feature of venous disease often overlooked and commonly undertreated.
Anxiety.[6]
Depression.[6]
Inflammation
Discoloration
Skin thickening
Cellulitis
Causes
Venous valves
The most common cause of chronic venous insufficiency is reflux of the venous valves of superficial veins.[2] This may in turn be caused by several conditions:
Deep vein thrombosis (DVT), that is, blood clots in the deep veins. Chronic venous insufficiency caused by DVT may be described as postthrombotic syndrome.
Superficial vein thrombosis.
Phlebitis
May–Thurner syndrome. This is a rare condition in which blood clots occur in the iliofemoral vein due to compression of the blood vessels in the leg. The specific problem is compression of the left common iliac vein by the overlying right common iliac artery. Many May-Thurner compressions are overlooked when there is no blood clot. More and more of them get nowadays diagnosed and treated (by stenting) due to advanced imaging techniques.[citation needed]
Deep and superficial vein thrombosis may in turn be caused by thrombophilia, which is an increased propensity of forming blood clots.
Arteriovenous fistula (an abnormal connection or passageway between an artery and a vein) may cause chronic venous insufficiency even with working vein valves.
Diagnosis
Further information: Ultrasonography of chronic venous insufficiency of the legs
B-flow ultrasonograph over a valve of the great saphenous vein, showing a venous reflux (flow toward right in the image).
Video is available
History and examination by a physician for characteristic signs and symptoms are sufficient in many cases in ruling out systemic causes of venous hypertension such as hypervolemia and heart failure.[7] An ultrasound can detect venous obstruction or valvular incompetence as the cause, and is used for planning venous ablation procedures, but it is not necessary in suspected venous insufficiency where surgical intervention is not indicated.[7]
Classification
CEAP classification is based on clinical, causal, anatomical, and pathophysiological factors.[8] According to Widmer classification diagnosis of chronic venous insufficiency is clearly differentiated from varicose veins.[9]
Management
Conservative
Conservative treatment of CVI in the leg involves symptomatic treatment and efforts to prevent the condition from getting worse instead of effecting a cure. This may include
Manual compression lymphatic massage therapy
Skin lubrication
Sequential compression pump
Ankle pump
Compression stockings
Blood pressure medicine
Frequent periods of rest elevating the legs above the heart level
Tilting the bed so that the feet are above the heart. This may be achieved by using a 20 cm (7-inch) bed wedge or sleeping in a 6 degree Trendelenburg position.[citation needed] Obese or pregnant people might be advised by their physicians to forgo the tilted bed.
Surgical
Surgical treatment of CVI attempts a cure by physically changing the veins with incompetent valves. Surgical treatments for CVI include the following:
Linton procedures (i.e. subfascial ligation of perforating veins in the lower extremity, an older treatment)[citation needed]
Ligation.[10] Tying off a vein to prevent blood flow
Vein stripping.[10] Removal of the vein.
Surgical repair.[10]
Endovenous Laser Ablation
Vein transplant.[10]
Subfascial endoscopic perforator surgery.[10] Tying off the vein with an endoscope.
Valve repair (experimental)
Valve transposition (experimental)
Hemodynamic surgeries.
Venous insufficiency conservative, hemodynamic and ambulatory treatment (CHIVA method) is an ultrasound guided, minimally invasive surgery strategic for the treatment of varicose veins, performed under local anaesthetic.[11]
See also
Atrophie blanche
Compression stockings
Lipodermatosclerosis
Venography
Venous stasis
Venous ulcer
References
^"Chronic Venous Insufficiency". Society for Vascular Surgery. December 1, 2009.
^ abWhiteley MS (2011). "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers". Whiteley Publishing. Retrieved January 8, 2015.
^Evans CJ, Fowkes FG, Ruckley CV, Lee AJ (1999). "Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study.J Epidemiol Community Health. 1999 Mar;53(3):149-53". J Epidemiol Community Health. Retrieved January 8, 2015.
^Robertson LA, Evans CJ, Lee AJ, Allan PL, Ruckley CV, Fowkes FG (May 2014). "Incidence and risk factors for venous reflux in the general population: Edinburgh Vein Study. Eur J Vasc Endovasc Surg. 2014 Aug;48(2):208-14. doi: 10.1016/j.ejvs.2014.05.017. Epub 2014 Jun 18". Eur J Vasc Endovasc Surg. Retrieved January 8, 2015.
^Avril, Stéphane; Badel, Pierre; Dubuis, Laura; Rohan, Pierre-Yves; Debayle, Johan; Couzan, Serge; Pouget, Jean-Fraçois (January 25, 2012). Gefen, Amit (ed.). Patient-Specific Modeling in Tomorrow's Medicine. Springer. p. 220. ASIN B00A9YFUDO. Retrieved August 2015. Check date values in: |accessdate= (help)
^ abcdefghiBarron GS, Jacob SE, Kirsner RS (Sep 2007). "Dermatologic complications of chronic venous disease: medical management and beyond". Ann Vasc Surg. 21 (5): 652–62. doi:10.1016/j.avsg.2007.07.002. PMID 17823046.
^ abPatrick C Alguire, Barbara M Mathes. "Diagnostic evaluation of lower extremity chronic venous insufficiency". Retrieved 2017-09-12. Topic last updated: Dec 04, 2017.
^Antignani, P. L. (August 2001). "Classification of chronic venous insufficiency: a review". Angiology. 52 Suppl 1: S17–26. doi:10.1177/0003319701052001S03. ISSN 0003-3197. PMID 11510593.
^Hafner, Jürg (1999-01-01). Management of Leg Ulcers. Karger Medical and Scientific Publishers. p. 81. ISBN 9783805566544.
Venous leg ulcers (VLUs) produce wound fluid (WF), as a result of inflammatory processes within the wound. It is unclear if WF from different healing phases of VLU has a peculiar biochemical profile and how VLU microenvironment affects the wound healing mechanisms. This study was conducted to evalua
Venous leg ulcers (VLU) are characterized by sustained proteolytic microenvironment impairing the healing process. Wound fluid (WF) reflect the biomolecular activities occurring within the wound area; however, it is unclear if WF from different healing phases have different proteolytic profiles and
Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.Clin Appl Thromb Hemost.2016 Oct;22(7):656-64. doi: 10.1177/1076029616645330. Epub 2016 Apr 21.
OBJECTIVES: To test for the presence of inflammatory biomarkers in blood taken from varicose veins versus antecubital blood of the same patient and compare this to levels in healthy controls.METHODS: Using a multiplex biochip array method (Randox, United Kingdom), the interleukins (ILs) IL-1α, IL-1
Chronic venous insufficiency or CVI is a medical condition where the veins cannot pump enough oxygen-poor blood back to the heart. It is sometimes referred to as an "impaired musculovenous pump", this is due to damaged or " incompetent" ...
When your leg veins cannot pump enough blood back to your heart, you have chronic venous insufficiency (CVI). CVI is also sometimes called chronic venous disease, or CVD. You have three kinds of veins: superficial veins, which lie close to ...
