What’s at the root of chronic venous insufficiency?
One risk factor for venous stasis disease, or chronic venous insufficiency, is something we do not often have control over: it can run in families.
We see it frequently in women who have been pregnant to term. They tend to report CVI symptoms during or after pregnancy. This is because there is a decrease in venous outflow from the legs from compression by the pregnant uterus.
Most of the time we see these symptoms — leg swelling, dark spots, or noticeable varicose veins — in older age because it’s a condition that progresses over time. The longer you are on your feet in your lifetime, and potentially, the more weight you gain as you age, and the less active you become, the more likely CVI might occur.
How is CVI diagnosed?
Most commonly, patients come to our clinic and present with pain, leg fatigue, or varicose veins that are unsightly, itching, or tender. Swelling is also associated with venous insufficiency, but it can also be caused by various other medical issues, including lymphedema.
We will then evaluate their legs with a venous reflux ultrasound. This is completed by a vascular technologist who assesses how efficiently — or inefficiently — the veins return blood to the heart.
Being that this condition is largely benign, what are common treatment options?
When I talk to patients, I inform them that anything that combats gravity is going to lessen symptoms. Sometimes this involves a procedural treatment, but in many cases, patients just need to wear compression garments, which will combat the weight of gravity on the veins right under the skin.
Increasing physical activity is extremely important because your body is designed to circulate blood when you move your legs. This is why experts recommend walking around every couple of hours on a long flight to prevent a blood clot. The same principle applies here. Furthermore, when you increase activity, oftentimes that results in weight loss, which will decrease pressure in your veins as well.
Another simple approach is elevating the legs when able, as this helps decrease swelling and pressure. All of these things combat gravity, which exacerbates symptoms.
Are there procedural fixes?
It depends where their venous insufficiency is located. If CVI occurs within the deep veins of the leg, we do not have a procedure we can offer patients. The best things they can do are utilize compression, leg elevation, increased activity, and weight loss.
When treating patients who happen to have venous insufficiency in their superficial veins, you can decrease flow through inefficiently functioning veins by closing them, which redirects flow deeper into the legs. This can be done with heat, alcohol, or glue. The idea is if you eliminate blood flow through the dysfunctional superficial veins, blood will take the path of least resistance and be routed to the deep system and away from the skin. This is what provides relief.
Does CVI impact overall health?
The biggest way CVI affects overall health is that it decreases activity. If it is severe and symptomatic, patients feel less inclined to move, which exacerbates the symptoms. CVI can make your legs feel tired and heavy, and, as you can imagine, exercise becomes less desirable. Movement can help alleviate discomfort, but it is difficult to exercise when you feel pain, heaviness, and fatigue in the legs.
At its worst, it can make daily activities difficult; however, in most cases, it is not life- or limb-threatening.
If somebody sees this news about the president and relates to the symptoms, what should they do?
The thing to know is that it is not typically dangerous, even if the presentation is very striking. Start by employing the interventions mentioned above and consider seeing a vein specialist. Treating CVI is not often a “quick fix,” but it can be managed and treatments are tailored to each patient.
My hope is that if people notice they are having the same symptoms, they will discuss it with their doctor. Education is the first step.
