Chronic Venous Insufficiency – a Review of Pathophysiology, Diagnosis, and Treatment

Written By Center for Vein Restoration
Chronic Venous Insufficiency

Many people who suffer from Chronic Venous Insufficiency may not know it’s a common vascular disorder. Chronic Venous Insufficiency affects millions of people worldwide and is considered a medical disability for those suffering from both long and short-term symptoms.

Chronic venous insufficiency is caused by poor functioning of the venous system, typically in the lower legs and feet. It can lead to a myriad of debilitating symptoms that impact your health and daily life, and get progressively worse if untreated. Some people suffering from chronic venous insufficiency can manage their symptoms with lifestyle changes, while others may need medical intervention to get symptomatic relief and eliminate the risks.

Read on for more information on how chronic venous insufficiency is diagnosed and treated, and how to mitigate the symptoms.

What is the Pathophysiology of Chronic Venous Insufficiency?

Chronic venous insufficiency is caused by impaired blood flow to the lower limbs, causing increased pressure in the veins and causes damage to the venous walls and valves. When this occurs the veins in your legs aren’t allowing sufficient blood flow back to your heart, causing the blood to flow backward or pool and can make the blood collect in your legs. Chronic venous insufficiency can be painful and cause other health conditions. If you suspect you have chronic venous insufficiency, you should contact a medical provider for a diagnosis.

Healthy veins have valves that ensure blood flows one way, which is up towards the heart. Someone suffering from chronic venous insufficiency has weakened or damaged valves, which causes the blood to pool in the veins.

Symptoms of Chronic Venous Insufficiency

The symptoms of chronic venous insufficiency can include the following:

  • Aching and camping in the legs or pain that gets worse when you stand but improves when you elevate your legs and feet

  • Swelling in the legs and feet

  • A tingling or numbness in the legs and feet

  • Skin changes such as wounds that don’t easily heal, irritated and cracked skin, red and weeping skin, and thickening of the skin of legs and ankles. This is often called lipodermatosclerosis and is characterized by a painful hardening and thickening of the skin.

  • Intolerance to standing and walking

  • Heaviness in the legs caused by swelling

  • Pitting edema, or swelling of the legs that holds an impression or dent when pressure is applied

  • Varicose veins

  • Spider veins

  • Increase of symptoms or onset of restless leg syndrome, including tingling, discomfort not relieved by movement, the frequent urge to move or reposition your legs, and the sensation of ‘crawling’ on the skin.

Chronic Venous Insufficiency Causes

Chronic venous insufficiency is very common. Approximately 150,000 a year are diagnosed with chronic venous insufficiency. Here are some of the more typical causes:

  • Smoking: Carbon monoxide and tar in cigarette smoke cause venous damage by lowering blood oxygen levels, which can cause inflammation in the veins.

  • Deep Vein Thrombosis (DVT): Deep vein thrombosis is a common cause of chronic venous insufficiency, as the clot can damage the valves that allow for blood flow to return to the heart. People with a history of deep vein thrombosis are at risk of or have developed chronic venous insufficiency.

  • Pregnancy: Women are also more likely to develop chronic venous insufficiency as the venous system is altered during pregnancy, both functionally and structurally. Hormonal changes during pregnancy can relax the vein walls, causing weakened valves. This coupled with an increase in blood volume during pregnancy can cause the venous valves to stretch or become weak, limiting the exchange of oxygenated blood.

  • Prolonged Standing: Being on your feet for long periods can cause the blood to pool in your legs and your veins to become inflamed, putting strain on your veins and the venous valves and potentially causing damage.

  • A Sedentary Lifestyle: Being inactive for long periods. A sedentary lifestyle or any condition that weakens the calf muscles can impair venous return, preventing oxygenated blood from getting back to the lower body.

  • Obesity: Fat cells can put pressure on veins in the legs and lower body, causing weakness and inflammation in the veins and valves.

  • High Blood Pressure: Much like being sedentary or prolonged standing, high blood pressure or anything that constricts the veins in the lower body can cause chronic venous insufficiency.

  • Calf Muscle Pump Impairment: This condition can be caused by injury, disease, a sedentary lifestyle, neurological issues, and more. Muscles in the leg provide a significant pump function to assist in recirculating venous blood back into the heart. This is sometimes called “the second heart”. An injury or weakness in the calf, foot, or leg muscles, or anything that prevents the muscles from working appropriately can negatively reduce venous return of blood to the heart.

  • Genetics and Family History: If you have a family history of obesity or high blood pressure, you’re at risk for chronic venous insufficiency. Some people with chronic venous insufficiency have genetic conditions that may impact the integrity of their vein walls or valves.

Men tend to see symptoms of chronic venous insufficiency around age 65-70, while women tend to see symptoms as early as their 40s.

Diagnosing Chronic Venous Insufficiency

Early diagnosis and treatment are vital for the treatment of chronic venous insufficiency. To diagnose chronic venous insufficiency, your doctor will perform a physical exam and ask about your symptoms, lifestyle, and family history. Your doctor will look for typical signs of chronic venous insufficiency, such as varicose veins, edema, and skin changes.

It’s vital to your treatment plan and diagnosis that you see a vein treatment specialist if you suspect chronic venous insufficiency may be the cause of your symptoms and discomfort. Your medical provider may use non-invasive imaging techniques like duplex ultrasound or venous pressure measurements. Unfortunately, chronic venous insufficiency can often be misdiagnosed as cosmetic spider veins if people don’t present with other symptoms, such as skin changes, venous ulcers, or edema.

It’s important to make sure you’re seeking treatment and diagnosis from a cardiovascular surgeon or vein treatment specialist, as untreated chronic venous insufficiency can lead to disabling and life-threatening conditions such as:

  • Chronic pain

  • Skin ulcers and chronic wounds

  • Deep vein thrombosis

  • Blood clots

At Center for Vein Restoration (CVR), we diagnose chronic venous insufficiency with the following non-invasive methods:

  • Physical Exam: Our physical exam includes a comprehensive history and time with your provider inspecting the skin for irregularities or bulging veins, and examining the skin’s surface to look for venous insufficiency or signs of fullness or swelling due to edema. We’re also looking for active or healed ulcers and vein tenderness that can indicate chronic venous insufficiency.

  • Non-Invasive Ultrasound Imaging: Chronic venous insufficiency comes with a wide range of symptoms. Non-invasive and radiation-free, ultrasound imaging is a safe and effective part of the diagnostic process. Imaging is critical for locating the areas experiencing venous incompetence in both your superficial and deep vein systems. An effective treatment plan can’t be determined without venous imaging.

  • Venous ultrasound is less invasive and just as accurate as comparable treatments such as venography, which relies on injecting dye into the veins via a catheter making the procedure invasive. Some patients require Doppler ultrasound, which evaluates blood flow through the blood vessels, including arteries and veins. Doppler vein mapping helps detect blockages and clots and can provide a more detailed assessment of abnormal blood flow to the lower extremities and other affected areas.

Chronic Venous Insufficiency Treatment

You have options when it comes to treating your chronic venous insufficiency. Your treatment options depend on the severity of your symptoms, and you and your CVR specialist near you will weigh your options and find the best treatment for you. You can manage symptoms of chronic venous insufficiency, but symptom management alone does not prevent it from progressing to something more serious.

In the past, a popular procedure called SEPS or subfascial endoscopic perforator surgery was typically recommended, a procedure that requires hospital admittance and is performed under general anesthesia. While it had a high success rate, there were additional risks and complications for patients with chronic venous insufficiency. At Center for Vein Restoration, we recommend the following treatments:

Non-Invasive Chronic Venous Insufficiency Treatment:

  • Compression stockings to improve circulation by applying gentle pressure to the affected area.

  • Lose weight and maintain a vein-healthy diet to reduce the pressure on your veins and legs.

  • Get help to quit smoking, as avoiding tobacco products will improve your blood oxygen levels.

  • Get more exercise. If you’re unsure where to start, just knowing a little bit of movement can make a big difference. Going for a daily walk can help increase healthy circulation and move fluid out of your lower extremities.

  • Consider medication and supplements, but talk to your doctor about anything you may be taking or are interested in taking.

Chronic venous insufficiency can have serious complications, including deep vein thrombosis. Consider all your options and the progression of your chronic venous insufficiency, as you may need a minimally invasive procedure to eliminate chronic venous insufficiency and its risks.

Procedures for Chronic Venous Insufficiency at Center for Vein Restoration:

  • Sclerotherapy is a procedure that involves injecting a small amount of a saline-based solution into spider veins and smaller varicose veins, causing the vein walls to scar and collapse, so blood will divert to healthier veins.

  • Ambulatory Phlebectomy is a minor surgical procedure where a bulging vein is extracted through small incisions, allowing the blood supply to reroute to healthier veins. This is an in-office outpatient procedure that requires a local anesthetic. Patients experience only temporary bruising or swelling and can immediately return to normal activity with few restrictions.

  • Thermal or Laser Ablation: This procedure replaces the “vein stripping” and other out-of-date procedures. During this thermal ablation, a thin fiber is inserted through the skin into the damaged vein. The vein collapses due to short bursts of heat and energy, causing the affected vein to collapse and the blood supply to reroute to healthy veins.

  • VenaSeal: VenaSeal is a new procedure done in the office that eliminates the risk of nerve injury. A thin catheter is inserted into the vein to deliver medical adhesive to seal the vein shut, directing blood flow to healthy veins. VenSeal is comparable to other procedures and less invasive.

  • ClariVein: This office-based procedure combines a dual approach to eliminate the diseased vein. An experienced vein specialist should perform this procedure involving mechanical and chemical treatment components. Using a rotating catheter tip and the administration of a sclerosing agent, blood flow is successfully blocked to the affected vein.

All of these treatment options for chronic venous insufficiency are done in the office and require minimal recovery time. Our procedures are safe, comfortable, and effective, allowing you to get back to your regular activities in just a few days, eliminating the painful symptoms from these damaged veins.

Chronic Venous Insufficiency Recovery

Chronic venous insufficiency is a complex vascular disease and can present a broad range of symptoms. Finding a vein specialist who can appropriately diagnose, treat, and help create a care plan is an essential part of managing symptoms and preventing complications, helping you improve your quality of life. 1 in 4 adults needlessly suffer from chronic venous insufficiency when minimally invasive treatment is available.

Using the most advanced vein treatment options and patient-centered approach, Center for Vein Restoration’s board-certified vein specialists help you regain your quality of life. We provide expert diagnostic care, and a comprehensive treatment plan aimed at eliminating the symptoms of chronic venous insufficiency while preventing complications and letting you get back to your daily routine.

Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.

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