Chronic venous insufficiency is a frequently encountered pathology in current medical practice and is due to a combination of factors, among which are venous valvular incompetence, prolonged orthostatism, obesity, age over 50 and genetic predisposition.
In certain situations, venous dysfunction can contribute to the formation of intravascular thrombi (blood clots) with the appearance of thrombophlebitis, a pathology with a risk of unfavorable evolution, which requires the institution of anticoagulant treatment and careful medical supervision.
What is chronic venous insufficiency (CVI)?
Can venous insufficiency be prevented?
How do we improve peripheral circulation?
Venous insufficiency treatment
What is chronic venous insufficiency (CVI)?
Chronic venous insufficiency is a medical condition that involves poor circulation of blood from the periphery, mainly represented by the pelvic limbs, back to the heart for reoxygenation. Venous circulation involves an anti-gravitational movement of blood, the optimal development of which implies the existence of a competent valve system, efficient contraction of the muscles of the lower/upper limb and, last but not least, a good functioning of the heart.
The venous system is provided with some valves, formations with the appearance of a swallow’s nest at the level of the endothelium, which prevent stagnation of blood and ensure its unidirectional movement by directing it towards the heart. Valvular incompetence can be primary, due to genetic causes (people have congenital valvular incompetence) or secondary, associated with some post-thrombotic events.
In most cases, patients diagnosed with chronic venous insufficiency have secondary valvular incompetence (between 80-95% of cases) that occurs as a result of damage to these structures in the context of an acute thrombotic episode. The post-thrombotic syndrome is a late complication due to an episode of acute venous thrombosis, which develops with the damage of the valves at the level of the thrombosed vein, but also of the adjacent perforating veins, the increase of blood flow in the superficial circulatory system and the appearance of secondary varicose dilations.
Pathological changes in the venous structures involved in ensuring the return of blood from the periphery to the heart determine, over time, the appearance of edema in the lower limbs, accompanied by pain and dilation of the superficial veins, initially in the form of telangiectasias that can evolve to spider veins – in ” spider’s web” and varicose veins. The unfavorable evolution of chronic venous insufficiency includes the appearance of varicose ulcers, which, untreated, can lead to extensive infections, tissue necrosis and amputation of the affected limb.
CVI risk factors
The main risk factors involved in the occurrence of chronic venous insufficiency are represented by:
- Family antecedents of chronic venous insufficiency
- Age greater than 50 years
- Personal history of deep vein thrombosis
- The female sex
- Multiparity (multiple tasks)
- Prolonged orthostatism (the person stands for long periods)
- Carrying out activities that involve frequent lifting of weights
- Sedentary lifestyle
- Arterial hypertension
- Excess weight
Can venous insufficiency be prevented?
Chronic venous insufficiency can be prevented with the help of regular physical exercises, walking and swimming, these being activities that facilitate the action of the muscle pump that contributes to venous return.
In the case of patients whose profession requires orthostatism for long periods or sedentarism, it is recommended to periodically perform several successive calf flexion movements on the thigh and extension, to stimulate venous return.
Reducing excess weight by adopting a healthy diet along with avoiding hot baths, saunas and exposure to high temperatures are other measures that contribute to the prevention and unfavorable evolution of chronic venous insufficiency.
How do we improve peripheral circulation?
Improving venous return can be achieved by applying measures that include:
- Walking contributes to the good functioning of the cardiac and vascular system, having a beneficial effect on peripheral blood circulation
- Stretching exercises relieve muscle tension, improve venous return and prevent the occurrence of peripheral edema and muscle cramps.
- Swimming, walking in the water and water sports support the good functioning of the circulatory system and tone the entire body’s muscles, while having a reduced impact on the joints (manages the joints by avoiding their overuse)
- Cycling trains the calf muscles and improves venous return from the periphery back to the heart
- Lower limb massage stimulates both blood and lymphatic circulation, but it cannot be performed in patients with established thrombophlebitis or active varicose ulcers
- Adopting a correct posture during professional activities, avoiding the leg-over-leg position and the distribution of the entire body weight on a single lower limb during prolonged orthostatism. After completing the daily activities, during rest, it is indicated to place the lower limbs in a slightly elevated position (elevating the legs) to stimulate the venous return and to prevent the occurrence of edema
IVC diagnosis
The diagnosis of chronic venous insufficiency is established by the specialist with the help of the information obtained after the clinical examination of the patient and the color Doppler ultrasound, which provides details regarding the anatomy of the peripheral vascularization, the caliber and permeability of the veins, but also the direction of the blood flow from their level. Doppler ultrasonography is useful both for establishing the diagnosis of chronic venous insufficiency and that of post-thrombotic syndrome, through this investigation the pathological changes in the venous lumen that appear after an episode of thrombosis are highlighted.
Venous insufficiency treatment
The treatment of chronic venous insufficiency aims to improve the patient’s symptoms and prevent complications due to IVC. For this purpose, the doctor can recommend both pharmacological and non-pharmacological treatments that include:
- Changing the lifestyle with the adoption of an adequate diet to reduce excess weight, quitting smoking and including a regular exercise program avoiding a sedentary lifestyle and prolonged standing.
- Drug therapy can be carried out with the help of phlebotrophic drugs such as Detralex, pharmacological preparations that reduce capillary permeability, improve the resistance of vascular walls and relieve edema of the pelvic limbs in patients with chronic venous insufficiency.
- Compression therapy has the role of reducing venous hypertension and intensifies the role of the physiological muscle pump when it is properly applied by the indications of the attending physician. Compression therapy involves the use of elastic stockings or non-elastic compression stockings or with a reduced degree of elasticity, which compress the blood vessels of the legs, compensating to some extent for valvular incompetence.
- The interventional treatment of patients with chronic venous insufficiency includes a series of procedures including sclerotherapy and endovenous ablation for the cauterization of superficial venous dilatations. The larger surgical interventions performed in the case of chronic venous insufficiency may include micro phlebectomy or venous stripping depending on the particularities of the case and the indications of the vascular surgeon.
Complications of IVC
The complications of chronic venous insufficiency are represented by the trophic changes of the tissues that make up the affected limbs and are due to prolonged edema. On the surface of the edematous and thickened skin, brown hyperpigmented areas appear as a result of the decomposition of the hemoglobin pigments from the extravasated blood (venous hypertension causes the red blood cells to leave the vessel in the interstitial space).
Over time, the skin thins and atrophies with the appearance of a venous trophic ulcer, a persistent, usually wet lesion that presents an increased risk of superinfection with different types of bacterial germs. The venous ulcer is mainly caused by accidental microtraumas on the surface of the skin, which, in the absence of an adequate supply of oxygen and nutrients, do not heal properly and can develop into extensive infection, tissue necrosis and sepsis.
If you are faced with unsightly varicose veins and other symptoms specific to chronic venous insufficiency, such as edema in the lower limbs, pain and discomfort, contact your doctor for a specialist consultation. The phlebologist is a specialist in the diagnosis and treatment of venous diseases, but phlebology services are also provided within other medical specialties, vascular and cardiovascular surgery, plastic surgery and reconstructive microsurgery and cardiovascular medicine.
References:
- Chronic Venous Insufficiency, Robert T. Eberhardt, Joseph D. Raffetto – https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.006898
- Chronic Venous Insufficiency (CVI), Cleveland Clinic – https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi
- Venous Insufficiency, Scott M. Surowiec, Shivik K. Patel – https://europepmc.org/article/NBK/nbk430975