Chronic Venous Insufficiency

Varicose veins and deep vein thrombosis may contribute to venous congestion resulting in chronic venous insufficiency

020 Circulatory Superhighway of the Veins and the Lymphatics

Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is the more advanced form of chronic venous disease – the stage at which swelling, skin changes or ulcers appear (classes C3 to C6 of the international CEAP classification). It develops when the leg veins struggle to push blood back up to the heart.

Normally, one-way valves keep blood in your leg veins flowing upward, helped by your calf muscles (the "calf pump"). If the valves weaken, or a vein becomes blocked, blood pools in the lower leg and the pressure builds up. Standing or sitting for long periods, a family history, pregnancy and being overweight all make this more likely.

Symptoms

CVI can make your ankles swell and your calves feel tight, and your legs may feel heavy, tired, restless or achy – often worse after standing. It frequently goes together with varicose veins. Over time the raised pressure can cause skin changes and, in more advanced cases, sores (ulcers). The swelling can also draw in lymph fluid, which adds to it.

Causes

CVI is caused by long-standing high pressure in the leg veins, usually from weakened valves. It can also follow a deep vein thrombosis (DVT) – a clot in a deep vein – or phlebitis (an inflamed, clotted surface vein). A DVT causes sudden leg swelling and needs urgent attention, because a clot can break off and travel to the lungs (a pulmonary embolism).

Your risk is higher with a family history, being overweight, pregnancy, too little exercise, smoking, long periods of standing or sitting, and age over 50.

Tests

I ask about your health and symptoms and examine your legs and veins. To confirm the diagnosis, I may order a duplex ultrasound – a painless scan that shows how blood is flowing through your leg veins and how well the valves are working.

Treatment Options

Conservative

Many people with CVI can be managed effectively without a procedure. The mainstay is compression, with a few simple lifestyle steps:

Compression stockings – elastic stockings that squeeze the leg, lowering the pressure in the veins, reducing swelling and supporting the calf pump. Worn daily, they ease swelling and aching and help prevent ulcers from coming back. For most people this is a lifelong, everyday habit – put them on first thing in the morning.
Raise your legs when resting.
Walk and exercise to work your calf pump, and avoid standing still for long (flex your calves if you must stand).
Keep to a healthy weight and stop smoking.

Endovenous

Stenting
Opening a narrowed or blocked deep vein in the pelvis or groin with a balloon and stent (venous stenting) can help selected patients with severe symptoms. Published results show that most of these stents stay open in the medium term, and the European guideline (ESVS 2022) says stenting should be considered for symptomatic blockage of the iliac and femoral veins. This practice prefers conservative management and does not perform venous stenting; if you might benefit, I can refer you to a venous specialist.

This practice does not offer elective endovenous procedures for chronic venous insufficiency.

Surgery

Bypass surgery

Open surgical bypass of a blocked deep vein is rarely needed, is done only in specialised centres, and its results are variable. We prefer the least invasive option, which is no intervention.

This practice does not offer surgery for chronic venous insufficiency.

Reference
European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022.

This practice does not offer elective open or endovenous procedures for varicose veins or chronic venous insufficiency

Chronic Venous InsufficiencyAdvanced Wound Care: African Bandaging System (Low Resolution)Nonsurgical Management of Chronic Venous InsufficiencyPatient Roadmap for the Conservative Management of Chronic Venous InsufficiencyFor Patients: Management of Chronic Venous Disease of the Lower Limbs

Our Services:

Conservative Management

The majority of patients with chronic venous insufficiency can be treated effectively with the following:

Elevation of limbs at rest
Weight control
Exercise: walking, cycling, swimming
Smoking cessation
Compression bandages
Compression hosiery

WoundCare

The majority of patients who receive wound care at our practice, actually received compression bandages for uncontrolled oedema to prevent ulcers. This is offered as a free service to existing patients. Prevention is better than cure.

We offer the whole range of conservative wound care modalities as well as advanced wound care modalities including surgical debridement, negative pressure wound therapy and / or hyperbaric oxygen therapy for complex wounds related to venous insufficiency.

Emergency treatment of acute DVT

In selected cases of severe, recent deep vein thrombosis, catheter-directed thrombolysis (an endovenous procedure that dissolves the clot through a thin tube) is offered as an emergency procedure.

Services not offered at our practice:

Elective Endovenous Procedures

Vein ablation, venoplasty and venous stenting for chronic venous disease are not offered. We prefer the least invasive intervention, which is no intervention.

Venous Procedures

Open venous surgical procedures attempt to bypass obstructed veins or to remove diseased veins. We prefer the least invasive intervention, which is no intervention.

This practice does not offer elective open or endovenous procedures for varicose veins or chronic venous insufficiency. We manage complex wounds and offer conservative therapy for CVI.

If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact our rooms for a formal consultation.