Chronic Venous Insuffiency
Our veins have the difficult job of pushing our de-oxygenated blood up from our feet and legs back to the heart and lungs. This is an uphill battle, literally, especially as we age. Chronic venous insufficiency occurs when the vein walls and/or the vein valves malfunction and allow blood to pool. This leads to various problems with the legs, such as varicose veins, swelling in the legs and feet, and even skin ulcers and infection.
What Is Chronic Venous Insufficiency?
When our veins are moving the blood up from the feet, they enlist the help of the muscles in the feet and calves to contract and help squeeze the veins and push the blood upward with every step we take. Also, the veins have one-way valves to prevent blood from moving backwards.
Chronic venous insufficiency (CVI) occurs when one or more of the valves fails or doesn’t form a fully tight seal against backflow. This allows blood to leak backward, against the blood flow. This can be a result of a blood clot in the deep veins of the legs, a disease known as deep vein thrombosis. It can also be a result of aging, extended sitting or standing, or obesity. CVI is more common in women and in people over the age of 50. CVI is anything but rare — an estimated 40 percent of people in the U.S. have it.
What Are the Risk Factors for Chronic Venous Insufficiency?
There are certain risk factors that make it more likely a person will develop CVI. These are the most important risk factors:
- Varicose veins
- Deep vein thrombosis
- Extended periods of sitting or standing
- Being a female
- Being over the age of 50
What Are the Symptoms of Chronic Venous Insufficiency?
With some conditions, you can ride out the initial symptoms and see what happens. CVI is not one of those. This is because as CVI progresses it gets worse. It’s important to come to see us at The Vein Clinic if you have any of these symptoms:
- New varicose veins
- Tired, aching legs
- Swelling in the lower legs and ankles, particularly after periods of standing
- Leathery-looking leg skin
- Itching skin on the feet and legs
- Leg cramping
- Changes in skin color
- Skin sores (ulcers)
CVI that is left untreated increases the pressure and swelling in the legs until the tiniest blood vessels burst. If this happens, the overlying skin takes on a reddish-brown color, and it will likely be sensitive to being bumped or scratched. Sores, known as stasis ulcers, often form on the surface skin and then resist healing, which leads to infection.
On a less serious side, CVI also leads to varicose veins, the snaking veins that push the skin upward, usually on the calves.
What Should I Do If My Legs Start to Swell?
If left untreated, the swelling and pressure will burst the tiny blood vessels as described above. There are some steps you can take first to address the lack of efficiency in your leg veins.
Compression stockings are basically socks in different lengths and compressions. They are made with elastic that puts uniform pressure on your legs. This helps support the veins and move the blood.
Try not to sit or stand for a long time. If you do have to sit, try to stretch or wiggle your legs, feet, and ankles often to keep the blood moving. If you have to stand, take breaks and sit and elevate your feet.
Walking is a good way to boost blood flow and strengthen your legs.
If these actions don’t help, it’s time to call us at The Vein Clinic, as more aggressive treatment is necessary.
What Should I Do If My Skin Starts to Change on My Legs, Ankles, and Feet?
These are skin changes that can come from CVI:
- Darkening of the skin, typically a reddish-brown, dark brown, or rust color
- Rashes with tiny itchy bumps around the lower calf or ankle
- Painful, hard, dark-red or brown patches around the lower calf or ankle
- Venous ulcers around the inner or outer ankle
- Easily torn skin
A family doctor may misdiagnose these skin changes as a dermatological problem, such as eczema or contact dermatitis. But when these skin changes are accompanied by a feeling of heaviness in the legs and aching in the legs these are clear signs of CVI. When the skin starts to change, this is no longer the time for home treatments — it is time to call Dr. Reynolds at The Vein Clinic.
How Can the Leg Swelling and Skin Changes Be Treated?
While these can seem like separate conditions, they are the result of CVI. Dr. Reynolds first will examine your legs. This will include an ultrasound examination. If he establishes CVI, then he will create a treatment plan to reverse the condition. Treatment will start with conservative measures and progress from there, if necessary.
Here are some more of the more casual treatment approaches we often use first:
- Regular exercise, particularly walking
- Weight loss if the patient is obese
- Avoiding long periods of sitting or standing (if you do need to do this, take periodic breaks to flex and extend your legs and to elevate your feet)
- Leg elevation when sitting or lying down (legs above your heart)
- Compression stockings
- Antibiotics to correct any skin infections
Sclerotherapy is a long-used method of addressing spider veins and small varicose veins. We inject a salt solution into the vein. This irritates the lining of the blood vessel, causing it to swell and stick together, closing off the vein. For larger varicose veins, Dr. Reynolds uses foam sclerotherapy, as it allows the sclerosant agent to stay in the vein easier (without being pushed through by the blood) to more effectively close the vein.
Endovenous thermal ablation
Endovenous thermal ablation delivers similar results to sclerotherapy, but uses different means to get there. In this technique, called ClosureFast, Dr. Reynolds uses high-frequency radio waves to heat the vein walls, causing them to collapse. To do so a spaghetti-sized catheter is inserted into the vein and the RF energy is delivered. It converts to heat energy in the vein and the heat damages the vein wall, closing the vessel off. In both sclerotherapy and endovenous thermal ablation, blood in the vessel is re-routed by the body to an adjacent, hopefully, healthier, vein.
VenaSeal is another option, where a catheter is inserted, as with ablation, but instead of RF energy, a cyanoacrylate-based medical adhesive is injected into the vein. This basically glues the vein closed.
More rarely, Dr. Reynolds may recommend surgery to correct your CVI. This can include ligation and vein stripping, ambulatory phlebectomy, or a vein bypass.
What Happens If I Leave My Swelling Legs and Changing Skin Untreated?
If you choose to ignore these signs of CVI, your condition will worsen. What started as tired legs and mild aching, especially after periods of standing or sitting, will transition to swelling. This will start in the feet and ankles and move up into the entire lower leg. Next, your skin will darken as blood vessels burst. Now the pain will become more sustained and occasionally throbbing. Your legs will cramp while sleeping. Your skin will bleed easily, particularly around the ankles and lower leg. Then your skin will develop venous ulcers, usually around the ankle. These can become several inches in diameter. These can easily become infected, which brings in an entirely new set of health risks.
Bottom line — when you begin having leg aching, new varicose vein development, and any swelling, there is no reason to leave these problems untreated. These are all signs you have CVI and Dr. Reynolds and his team at The Vein Clinic will help you reverse the condition.
“I just wanted to say…. Thanks! I’ve very pleased with what is happening with my veins in just two treatments. My left ankle swelling and discomfort is now minimal and the ‘spider’ veins around my ankles are becoming less noticeable also! Thanks, Dr. Reynolds and good work Mary!” – C.N.
“Dr. Reynolds and staff were very professional and courteous. I was concerned about the entire procedure and he showed much interest in my recovery. I would recommend him highly to anyone.” – J.B.