Chronic Venous Insufficiency

What is chronic venous insufficiency?

Chronic venous insufficiency (CVI) is a disease caused by weak, worn, or damaged valves in the veins of the legs. It causes swelling (edema) of the legs and can also cause open sores especially in the ankle area.

Risk factors

Veins carry blood, against gravity, back towards the heart. To help this process, veins contain a series of valves that prevent blood from flowing backward. With CVI the valves may be weak or worn. When these valves become weak, blood has difficulty moving upward. Prolonged increased pressure in the veins causes the valves to stretch out, making them unable to close properly. As a result, the blood flows back into other veins and pools in the leg tissues, causing swelling and sometimes varicose veins. The pressure under the skin can also cause the skin to break open producing sores called stasis ulcers. These ulcers increase your risk of injury and infection and are often difficult to treat.

CVI is most commonly associated with previous blood clots, but in addition, obesity, inactivity, aging, and heredity can contribute to this condition.

Signs and symptoms

Swelling and/or pain in the legs, rash, enlargement of veins close to the surface of your skin; dry, cracked, itchy skin; changes in the skin color (red or brownish color), or skin ulcers (usually in the ankle area).

Treatment

Treatment is designed to reduce the pooling of blood and prevent ulcers and consists of elevation and compression. Elevate your legs above your heart at set times during the day to allow pooled blood to drain (at least 30 minutes every 2 hours). At night, sleep with your feet elevated about six inches by propping them on a pillow.

As leg elevation can be impractical during the day, special compression stockings may be prescribed. These stockings compress the veins close to the skin, thereby preventing blood from pooling and helping it to return to the heart more efficiently. Proper fit is very important. The stockings are designed to provide greater pressure at the foot and ankle and less pressure higher up the leg. Put the stockings on after a period of leg elevation, usually before you get out of bed in the morning and remove them when going to bed at night.

Surgery to correct venous insufficiency are performed rarely. More commonly procedures are based around the local area of the wound.

How do I take care of myself?

  • Elevate your legs and avoid long periods of standing or sitting.
  • Wear compression stockings if prescribed. Ideally, walking is better for your circulation. When you are sitting, avoid crossing your legs, wearing girdles, leg garters, or other tight-fitting garments which can have a tourniquet effect. Maintain a normal weight. Protect your legs and feet from injury. Keep your skin clean, dry, and soft. Call your health care provider's office right away if you see signs of sores developing.

What can be done to prevent chronic venous insufficiency?

CVI often cannot be avoided. However, symptoms can be controlled. A walking program that starts with only a few steps every day but builds slowly and steadily may help prevent the progress of this condition.