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Chronic Venous Insufficiency

Chronic venous insufficiency, or CVI, is characterized by the reversal of blood flow in the veins of the lower extremities, causing high pressure in the system with stagnation of blood and gradual swelling, discoloration and inflammation of the tissue. CVI can be caused by failure of the valves or obstruction of the deep veins, but more commonly involves the superficial system. This superficial system fails to carry the blood back toward the heart when the one-way valves fail, usually at a point where it joins the deep system in the groin or behind the knee. There are various factors that tend to cause this valve failure, but the most important seems to be heredity. Other factors, such as prolonged standing, multiple pregnancies, and extreme obesity may play a role as well.

Treatment of CVI consists of compression therapy, when possible. However, at least 60% of people are unable to tolerate the compression hose for long periods, and the non-compliance rate is even higher than this. Treatment then must address the cause of the high pressure, and this involves, in most cases, closing one or both of the main saphenous veins, removal of varicose veins, and stopping any connecting veins from the deep system that are contributing to the high pressure. Stripping of the saphenous veins has been replaced by thermal ablation, either radiofrequency or laser generated heat.

Ulceration of the lower leg, the end result of severe CVI, is usually caused by both saphenous reflux and reflux in connecting veins (perforators) that carry high pressure from the deep system into the superficial veins. An intense inflammatory condition ensues, with fibrosis and deposition of blood pigment. This tends to crowd out the blood vessels and makes it difficult for oxygen to get to the cells. A slight injury can then result in an ulceration that is difficult to heal. Even after appropriate treatment for the CVI and healing of the ulcer, lifelong maintenance of compression is recommended.