What to Expect if You Have Chronic Venous Insufficiency

Chronic venous insufficiency (CVI), or vein disease, causes lower extremity swelling, skin discoloration, and leg discomfort secondary to venous hypertension. The elevated pressure in the veins accounts for approximately 150,000 new diagnoses annually.

If left untreated, this common condition can progress to postphlebitic syndrome (also known as deep venous thrombosis, or DVT) and venous ulcers. A venous ulcer is a wound on the leg or ankle caused by damaged veins. Keep reading to learn how to improve your leg health using CEAP classification and early treatment. Read on to learn what CEAP stands for and how to use it to learn more about your vein condition.

What Causes Chronic Venous Insufficiency?

Adequate blood flow depends on strong and flexible vein walls, minimal plaque build-up, healthy vein valves, and exercise. These functions ensure blood flows from the feet and legs to the heart and lungs. When any of these aspects of vascular health are impaired, you are at risk for Chronic Venous Insufficiency.

Primary Chronic Venous Insufficiency

The etiology (cause) of Chronic Venous Insufficiency is categorized as primary or secondary. Primary Chronic Venous Insufficiency results from congenital defects (a medical condition that occurs at or before birth) or changes in the vein wall structure. Primary Chronic Venous Insufficiency may be present without a deep vein thrombosis (DVT) event and is responsible for 70 percent of vein disease.

Secondary Chronic Venous Insufficiency

Plaque, or fat build-up, adheres to the vein wall and can cause a blood clot. Blood clots can stop or slow blood flow. Deep vein thrombosis is a blood clot that lodges in the body's deep blood vessels.

Secondary venous insufficiency, or postphlebitic syndrome, triggers inflammation and injury to the vein as a response to a DVT event. Secondary Chronic Venous Insufficiency is symptomatic and accounts for 30 percent of Chronic Venous Insufficiency cases.

Regardless of the cause, both primary and secondary vein disease result from venous hypertension. Elevated pressure within the vein walls causes enlargement of blood vessels and strain on vein valves.

Blood vessels carry oxygen to cells and remove waste from the body. Veins that aren’t working properly produce insufficient oxygen supply, which means the whole body suffers when our veins suffer.

Risk Factors of Chronic Venous Insufficiency

Unfortunately, six to seven million Americans have an existing diagnosis of advanced venous disease. These individuals meet the criteria for diagnosis of Chronic Venous Insufficiency.

Many times we have no control over medical problems. Other times simple lifestyle modifications can make a significant improvement in health.

Risk factors we cannot change include:

• Female gender
• Advanced age
• Genetics or history of DVT
• Nonthrombotic iliac vein obstruction (May-Thurner syndrome)

Risk factors we can control include:

• Obesity
• Sedentary lifestyle
• Smoking
• Prolonged sitting or standing

Chronic Venous Insufficiency Staging and Diagnosis

Diagnosis of varicosities and Chronic Venous Insufficiency is based on clinical examination, patient history, and ultrasound imaging. These diagnostic tools are essential for confirmation of venous insufficiency. After diagnosis, your physician will assign a Chronic Venous Insufficiency stage score.

Vein disease staging helps providers better understand the progression of the disease, guide the treatment plan, and determine a prognosis. The staging score is based on clinical exams, the cause of the disease, and how blood flow is impacted.

Reported symptoms help your vein specialist adequately classify and treat vein disease. Signs your doctor will need to know about are the following:

• Dull, aching, and heavy legs
• Leg cramps
• Leg swelling (edema)
• Skin changes: red, crusty, thick, or weepy skin
• Varicose veins

Ultrasound imaging provides a visual for your provider to determine the direction and adequacy of blood flow. This diagnostic test also shows if venous reflux or blood pooling contributes to enlarged veins and malfunctioning valves.

CEAP Classification for Chronic Venous Insufficiency

CEAP scoring is an invaluable classification system developed in 1994, with the most recent revision completed in 2020. Medical professionals can create an evidence-based treatment plan and prognosis based on the severity score.

Physicians use this tool to guide decision-making for patients with symptoms indicating vein insufficiency. CEAP is an acronym for the words: clinical, etiology, anatomy, and pathophysiology.

Your provider or vein specialist evaluates each aspect of the CEAP acronym. However, the clinical component is most helpful in showing how the disease affects the body.

C — Clinical

Before giving a patient a score, physicians look for swelling, skin abnormalities, vein bulging, and ulcer formation. They assign a number based on the following physical observations:

• C0 = No visible signs of Chronic Venous Insufficiency
• C1 = Visible blood vessels
• C2 = Bulging veins (varicose veins)
• C3 = Skin changes
• C5 = Healed ulcer
• C6 = Open ulcer

E — Etiology

Determining the cause of vein disease is imperative for adequate and appropriate treatment. Simple solutions, like compression therapy, are often all that is needed. Other times, your vein specialist will recommend lifestyle changes or a minimally invasive technique.

Knowing the cause of Chronic Venous Insufficiency helps guide the treatment plan. Etiology can be classified as the following:

• Primary
• Secondary
• Congenital
• No known cause

A — Anatomy

Vein specialists must determine which veins are malfunctioning. The great saphenous vein, the small saphenous vein, and the perforator veins (connecting veins) are all impacted by venous hypertension.

Determining the location of vein damage, blood pooling, or venous reflux directs the treatment plan. The anatomy classification is based on which of the following blood vessels Chronic Venous Insufficiency affects:

• Superficial veins
• Deep veins
• Perforator veins
• No obvious anatomic location

P — Pathophysiology

Pathophysiology refers to the path that caused the change in function. Evaluating this aspect of chronic venous insufficiency shows how blood movement is affected.

The specific cause of the insufficient vein determines the pathophysiology score.

• Obstruction, blood clot, DVT
• Venous reflux
• Obstruction and venous reflux
• No venous pathology

Treatment of Chronic Venous Insufficiency

Varicose veins and vein disease treatment have come a long way. Minimally invasive techniques show phenomenal results. These in-office procedures increase quality of life scores, prevent complications, and improve prognosis (outcomes).

Radiofrequency ablation (RFA)

Vein specialists often use radiofrequency ablation to treat saphenous and perforator veins. A thin tube, also known as a catheter, is inserted into the skin, and high-frequency sound waves heat and seal the affected vein.

Endovenous laser ablation (EVLA)

Endovenous laser ablation (EVLA), also called laser ablation, works much like RFA. Vein specialists often use laser ablation instead of the outdated “vein stripping” method to treat varicose veins.

Both RFA and EVLA close the damaged vein. However, laser ablation uses high-intensity light, instead of radio waves, to apply heat. After vein closure, the blood is redirected naturally to healthy blood vessels.

Ultrasound-guided foam sclerotherapy

Under the guidance of an ultrasound, physicians inject foam sclerosant. This medication causes a chemical reaction that seals off the ineffective, damaged vein. Physicians generally use this treatment method for smaller varicose veins and spider veins.

These procedures provide incredible results for people suffering from venous insufficiency and varicose veins. These three treatment modalities aim to seal the malfunctioning blood vessel and reroute blood to healthy veins. The unsightly, painful varicose veins quickly disappear, and Chronic Venous Insufficiency prognosis improves.

What are Venous Stasis Ulcers?

Venous ulcers are sores caused by inadequate blood flow. When veins strain to move oxygen-deficient blood against gravity, blood pooling results and creates added pressure. The diminished oxygen supply and decreased ability to remove waste from the affected area impair healing. Therefore, these painful wounds take longer to mend.

Venous ulcers are common and challenging to treat. These sores are painful and can become debilitating. Nearly 60 percent of Chronic Venous Insufficiency patients develop inflammation in the veins, with more than 50 percent of these cases leading to a DVT event.

Prognosis after Endovenous Laser Ablation

Chronic venous insufficiency is a progressive condition, meaning it gets worse if left untreated, and can lead to more serious conditions.

This disorder carries life-threatening consequences without intervention. Thankfully, advancements in vascular treatment have come a long way. The previously mentioned endovenous therapies are just a few innovative techniques vascular care providers utilize in vein care.

These endovenous treatment procedures show significant improvement in CEAP scores. Vein closure of the greater saphenous vein using laser ablation proves to have a 90 – 98 percent success rate after two years. According to this study, 87 percent achieved complete relief of varicose veins and blood reflux.

Not only are these treatments showing incredible results, but they are also associated with shorter recovery times when compared to surgical methods. With proper treatment of varicose veins and Chronic Venous Insufficiency, the prognosis is good.

However, 1 – 2.7 percent of venous insufficiency sufferers develop venous stasis ulcers (ulcers are due to abnormal vein function), which are associated with severe Chronic Venous Insufficiency. Sadly, venous ulcer formation results in a poor prognosis, with 40 percent of patients developing recurring sores. The good news is that you can achieve vascular health and a better prognosis with early treatment.

In Conclusion: Early Classification and Treatment for Chronic Venous Insufficiency Improves Prognosis

Chronic venous insufficiency and varicose veins are common conditions that cause cosmetic concerns, decreased quality of life, and the risk of venous ulcers. With modern imaging, classification scoring, and minimally invasive techniques, outpatient treatment of insufficient veins produces phenomenal success rates. Early treatment delivers high patient satisfaction and an improved prognosis.

Center for Vein Restoration (CVR) improves lives with state-of-the-art vein care. We are redefining vein treatment with our comprehensive and compassionate therapy. Since early treatment is vital, contact us today at 240-965-3915 or schedule an appointment at one of our more than 110 vein clinic locations.