Chronic Venous Insufficiency

Medical specialist	Vascular Surgery
Symptoms	Leg pain, varicose veins, heavy legs, and cramps
risk factor	Female, pregnant, over 50 years old, obesity, and family history
Cara diagnosis	Medical interview, physical examination, supporting examination
Treatment	Compression stockings, drugs, ablation and surgery
Drug	Antibiotics, Anticoagulants
Complications	Leg injuries, pulmonary embolism, deep vein thrombosis
When to see a doctor?	Constant pain in legs, varicose veins, family history of CVI

Understanding 

Chronic venous insufficiency or CVI is a disorder of blood flow in the legs due to the valves in the veins not working properly.

Under normal conditions, blood will flow throughout the body through the veins and then return to the heart.

But in CVI, the veins in the legs can’t drain blood to the heart because the valves and the walls of the veins are weakened.

As a result, blood cannot flow to the heart and accumulates in the leg veins. This collection of blood in the legs is also known as stasis.

The incidence of CVI in the adult population in America is estimated to range from 5-30 percent. Meanwhile, there is no literature regarding the incidence of CVI.

Reason 

The main cause of chronic venous insufficiency is a malfunctioning of the valves in the veins. This condition can be triggered by:

• Congenital conditions or blood vessel abnormalities from birth
• Have had a leg injury or history of blood clots
• Deep Vein Thrombosis  or buildup in the deep veins
• The habit of sitting or standing for too long can weaken the venous valves
• Over 50 years old. Blood vessels weaken with age

Symptoms 

The most common symptom of chronic venous insufficiency is leg pain. In addition, other symptoms such as:

• Swelling of the legs and feet feels heavy
• Itching of the limbs
• Varicose veins
• The skin color of the limbs turns dark
• Cramps in the limbs

Risk Factors 

Below are some of the risk factors for  chronic venous insufficiency :

• Age over 50 years
• History of varicose veins
• Family history of CVI
• Female gender
• is pregnant
• Have ever had deep vein thrombosis
• Obesity and lack of physical activity
• Standing or sitting for long periods of time

Diagnosis 

Physical examination and supporting examinations are the methods used to diagnose CVI. Here’s an explanation.

1. Duplex ultrasound of the leg

A duplex ultrasound examination is done so that the doctor can get an overview of the veins so that clots or malfunctions in the veins can be detected.

The doctor will attach and press the ultrasound to the swollen part of the patient’s leg.

2. Venography

Venography is a procedure to see the veins with the help of contrast so that the blood vessels can be seen more clearly.

3. MRV (Magnetic Resonance Venography)

This procedure is also intended to see the veins. As the name suggests, MRV uses magnets to create images of the veins.

Treatment 

In cases of mild CVI, doctors will usually advise patients to exercise regularly and avoid sitting cross-legged.

The doctor will also recommend leg elevation or positioning the feet higher than the heart when sitting or lying down.

In addition, the doctor may recommend the patient to wear special stockings.

These stockings can help improve blood flow, and swelling in the legs can also be reduced.

If the use of compression stockings is not effective, several other treatment procedures can be performed, namely:

1. Drugs

Drugs that are usually used to treat  chronic venous insufficiency  are:

• Blood thinners (anticoagulants), can be in the form of injections or oral medication
• Antibiotics, to treat infections due to cuts in the skin
• Diuretic drugs, so that fluids in the body come out and do not accumulate in the limbs

2. Non-surgical medical procedures

Before entering into surgery, there are several non-invasive measures that doctors can consider, such as:

• Sclerotherapy, namely injecting a  sclerosant substance  so that the blood vessels shrink
• Endovenous laser ablation, by obliterating the vein using a laser beam. This procedure is performed by an interventional radiologist
• Radiofrequency ablation  (RFA), which is heating an injured vein using high-frequency radio waves. This procedure is performed by an interventional radiologist

3. Surgical Procedures

If non-invasive therapy fails or in severe CVI conditions, a vascular surgeon will suggest surgery or surgery.

The goal is to:

• Repair damaged veins or valves
• Lifting the veins affected by CVI
• Perform new vein grafts ( venous bypass  ) so that blood flow does not pass through the veins that are experiencing CVI
• Binding or closing damaged veins

Prevention 

Although it cannot guarantee 100 percent, there are several steps that can be taken to minimize the chance of CVI occurring.

This prevention can take the form of:

• Improved lifestyle such as exercise, smoking cessation, and balanced nutrition
• Avoid sitting or standing for too long
• Check yourself with a doctor if there is a history of CVI in the family

Complications 

Some of the complications that can arise due to  chronic venous insufficiency  are:

• Stasis ulcers or sores on the legs
• Pulmonary embolism
• Deep vein Thrombosis

When to See a Doctor?

If you experience unusual leg pain and are accompanied by any of the above symptoms, immediately consult a doctor.

Untreated CVI can cause the capillaries to swell and even burst. This condition can increase the risk of infection and cellulitis in the tissue around the blood vessels and the emergence of wounds that are difficult to treat.

If you have ever experienced the symptoms mentioned above, don’t hesitate to consult a specialist immediately.