Chronic Venous Insufficiency (CVI)
Chronic Vein Insufficiency (CVI) is a common condition that primarily affects the lower limb. CVI develops due to valvular incompetence resulting in reflux (backwards flow) or obstruction within the veins. This may occur in deep, superficial or perforating veins causing venous hypertension in the affected extremities.
Superficial venous incompetence is usually due to valve pathology, our valves open to allow forward flow of blood back to the heart and close to prevent backward flow and pooling in our lower limb. Congenital defects, trauma and lifestyle factors can cause defects in valve shape, size and strength. Wide vein diameter can also influence valve efficacy and prevents congruency along the system resulting in reflux and vein distension.
Perforating vein pathology results in reduced pressure control from deep to superficial venous systems. Increased dilation results in inability for valves to close adequately and generally predisposes superficial system dysfunction.
Deep vein dysfunction is usually associated with deep vein thrombosis (DVT) which results in inflammation, vein scarring and adhesions, and luminal narrowing.
As the condition progresses to the later stages, CVI can present significant burden in terms of morbidity, healthcare costs and a decrease in patient quality of life due to pain, discomfort, and embarrassment, which can lead to anxiety or depression.
Who is at risk?
There are a number of risk factors that can contribute to someone developing CVI, these include:
- Advanced age
- Females (the prevalence for women is 25-40%, whilst in men it is 10-20%)
- Family history
- Obesity
- Pregnancy
- Use of oral contraceptives’
- Hypertension (high blood pressure)
- Leg injury
- Congenital valve deformity
- Sedentary lifestyle
- Standing for long periods of time
- History of deep vein thrombosis.
How do I know if I have CVI?
It is important not to diagnose yourself, if you are seeing any of the changes listed above in your lower legs or experiencing pain and discomfort, please contact us today for a full lower limb health assessment.
What does CVI look and feel like?
The early stages of CVI begin with spider veins and varicose veins, this can then lead to swelling of our lower limb. The swelling is most prominent around the ‘gaiter region’ which is between our calf muscle and ankles. Swelling can also progress upwards towards the knees or on the tops of the feet. The stage of CVI when swelling occurs is predominantly when people begin to feel discomfort, heaviness, or the feeling of a “wooden leg”, this can occur at any time, however it is much more prominent at the end of the day. These symptoms are often relieved with leg elevation or the use of compression.
Persistent swelling disrupts the microcirculation to our skin, meaning the skin isn’t getting enough oxygen and nutrients, this will lead to the next stage of the disease which are skin changes. The skin can become itchy, pigmented, thickened and fibrotic. The skin changes are a critical aspect of CVI, if left untreated, or managed poorly this can lead to a venous leg ulcer, which is the most serious complication to stem from CVI. A venous leg ulcer can cause significant pain, and mobility issues.
The development of a venous leg ulcer has seen 45% of people become housebound and 50% of people suffering with their daily activities. People with advanced CVI are at a higher risk of thrombus, 60% of people are likely to develop phlebitis (inflammation of a vein) which in 50% of cases will lead to DT and higher risk of pulmonary embolism.
CVI is a progressive disorder, which means that it has several stages and if not managed or treated accordingly, it can progress into the more serious stages of the disease. Outcomes for patients with CVI are variable, but when it is left untreated it can lead to severe health concerns, so it is crucial CVI is managed and controlled from the early stages.
CVI classification system
The American Venous Forum created a classification system in 1994 aiming to universally diagnose chronic venous conditions. After revision in 2004 the CEAP classification was identified and remains in use today.
CEAP stands for Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P) and is broken into 7 categories.
What can be done?
Your podiatrist will take a full medical history and conduct a lower limb health assessment which includes a blood flow analysis. Following the results of your assessment a treatment plan will be put together. This may include an exercise prescription, education of the condition, topical medications, advice on how to keep your skin happy and healthy, a thorough discussion about elevation and compression therapy or a referral to your GP for further assessment if deemed necessary. It is important to note that compression therapy and certain exercises are not suitable for everyone depending on your medical history. Before undertaking any management strategies of your condition please call us today or book online!
