Varicose veins are a common problem among both women and men, especially from middle age. One major contributing factor in the development of varicose veins, or which occurs alongside them, is chronic venous insufficiency (CVI). It is a long-term issue that should be addressed to minimise the risks of developing uncomfortable, unsightly varicose veins and other health concerns.
What is Chronic Venous Insufficiency?
CVI is a common medical condition that occurs when the walls of veins, or the valves within the veins, do not work properly. It is significantly more common in the legs, especially the lower legs. The result of the failure of the vein structure to work properly is that blood collects or pools in the veins instead of being swiftly returned to the heart. In turn, this has detrimental effects on the function of the veins, and both the health and appearance of the legs.
CVI can affect anyone but it is more common in people over the age of 50 years and more in women than men.
What Causes This Condition?
The veins are the body’s organs that return blood from the tissues to the heart (whereas the arteries take blood from the heart to the tissues). For much of the body, this means that veins must work against gravity to send blood to the heart – and this is further complicated as the pressure of blood flowing in veins is far lower than it is in arteries.
Blood flow from the legs has the greatest distance to travel and is most impacted by gravity. In healthy legs, this is assisted by:
- Muscles in the feet and calves contract to help squeeze the veins to force blood upwards.
- Healthy vein walls are strong to support upwards blood flow.
- One-way valves within the veins prevent blood from flowing backwards.
When a person experiences chronic venous insufficiency, the valves become damaged, and the vein walls may also weaken.
Damaged valves allow blood to leak backwards in the veins, where it can pool in the lower legs or ankles and become stagnant and more prone to clotting. This also makes it more difficult for blood to return to the heart, increasing the blood pressure in the veins and creating a chronic, long-term problem that deteriorates over time if it is not treated.
CVI most commonly occurs after a deep vein thrombosis (DVT), which is a blood clot that develops in the deep veins within the legs. This happens because the blood flow is obstructed by the clot, and blood builds up below the clot, putting pressure on the walls and valves in the vein and weakening them. Up to 30% of DVT sufferers will develop CVI within ten years of their DVT diagnosis.
CVI can also result from:
- Valve damage due to ageing
- Valve damage due to extended sitting or standing
- Reduced mobility
- Previous injury or surgery to the leg
- Being overweight/obese
- Lack of exercise
- Weak leg muscles
- Varicose veins
- Phlebitis (inflammation and swelling in a superficial vein)
- Vascular malformations – including missing or impaired valves
- Pelvic tumours (relatively rare)
Signs and Symptoms of CVI:
- Swollen lower legs/ankles
- Aching and heaviness in the legs
- Weakness in the legs
- Tight feeling in the calves
- Cramping or pain
- The new appearance of varicose veins
- Brownish coloured skin near the ankles
- Dry, leathery skin appearance on the legs
- Skin thickening on the lower legs or ankles
- Itching or flaking on the skin of the legs/feet
- Venous stasis ulcers
Untreated CVI will result in the pressure within the legs increasing until the point when the legs swell and tiny capillaries burst. This causes the skin overlying these tiny vessels to become discoloured and vulnerable to breakage if it’s scratched or bumped. This in turn leads to local inflammation, internal tissue damage, and potentially ulceration.
Venous stasis ulcers are open sores that develop on the skin over damaged blood vessels. These are difficult to heal and may become infected. Uncontrolled infection can develop into cellulitis, where it spreads to surrounding tissues and can be a very serious condition.
Treatment of CVI
CVI must be diagnosed and treated as early as possible. Treatment will depend upon your age and overall health, the severity of your case, your symptoms, and other factors.
Diagnosis is made via:
- A complete medical history
- Physical examination
- Vascular ultrasound
- Venogram (possibly)
Treatment approaches may include:
- Improving circulation within the legs via regular exercise, wearing compression stockings, and/or elevating the legs.
- Losing weight helps reduce pressure in the legs and maximises overall health and wellbeing.
- Drug therapy, including aspirin to thin the blood to increase flow through the legs, or diuretics to remove excess fluid from the body via the kidneys. These options must be carefully weighed against your overall health and other existing medical conditions.
- Antibiotics to treat skin infections. Maintaining good skin hygiene is important as well.
- Endovenous laser ablation to close the vein to reduce pooling in the leg.
- Sclerotherapy to eliminate the affected vein.
- Surgery for the most severe of cases if minimally invasive approaches are not effective.
Tips for CVI Prevention
- Maintain a healthy weight
- Exercise regularly
- Drink plenty of fresh water
- Consume a healthy, balanced diet rich in fresh fruits and vegetables and whole grains, as well as healthy proteins
- Quit smoking
- Moderate alcohol consumption
- Avoid prolonged sitting/standing where possible
- Avoid wearing restrictive clothing
- Limit wearing high heels
Visit Crows Nest Vein Clinic
Crows Nest Vein Clinic is conveniently located on Sydney’s Lower North Shore, close to public transport. Our Vein Specialist Dr Nicole James has the exceptional training, skill, expertise, and empathy to understand her patients’ concerns and offer the right surgery-free treatment approach for the very best health and cosmetic outcomes.
As an essential medical service, our vein clinic is open and compliant with all NSW Health COVID-19 guidelines.