Chronic Venous Insufficiency (CVI)

Symptoms

• Varicose veins
• Ulceration or skin breakdown
• Lipodermatosclerosis
  
• Reddened or discolored skin on the leg
• Oedema

Risk factors

• Heredity
• Obesity
• Pregnancy
• Sedentary lifestyle
• Smoking
• Jobs requiring long periods of standing or sitting in one place
• Age and sex (women in their 50s are more prone to developing CVI)
• Incompetent valves
• previous DVT

Pathophysiology

• Increased venous pressure transcends the venules to the capillaries, impeding flow.
  

• Low-flow states within the capillaries cause leukocyte trapping.

• Trapped leukocytes release proteolytic enzymes and oxygen free radicals, which damage capillary basement membranes.

• Plasma proteins,such as fibrinogen, leak into the surrounding tissues, forming a fibrin cuff.
  

• Interstitial fibrin and resultant oedema decrease oxygen delivery to the tissues, resulting in local hypoxia.
  

• Inflammation and tissue loss result. Ulceration may occur.
  

Management

• Leg elevation
  
• Elastic compression therapy - especially with older patients you need to ensure they are actually able to put the compression stockings on for themselves.
  
• Sclerotherapy - chemically scarring the veins from the inside out so that they can then no longer fill with blood. Blood that would normally return to the heart through these veins returns to the heart through others. The body eventually absorbs the veins that received the injection.
• Vein stripping
• Deep vein surgery - note that surgical treatment is reserved for those with discomfort or ulcers refractory to medical management.
• Valve repair