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Chronic venous insufficiency

Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein.[1] The most common cause of CVI is superficial venous reflux which is a treatable condition.[2] As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease.[3] It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.

Chronic venous insufficiency

Chronic venous disease

Vascular surgery

Most cases of CVI can be improved with treatments to the superficial venous system or stenting the deep system. Varicose veins for example can now be treated by local anesthetic endovenous surgery.


Rates of CVI are higher in women than in men.[4][5] Other risk factors include genetics, smoking, obesity, pregnancy, and prolonged standing.[6]

Varicose veins

Itching ()

pruritus

Hyperpigmentation

[7]

Phlebetic lymphedema

Chronic swelling of the legs and ankles

Leg ulcer

Signs and symptoms of CVI in the leg include the following:


CVI in the leg may cause the following:

(DVT), that is, blood clots in the deep veins. Chronic venous insufficiency caused by DVT may be described as postthrombotic syndrome. DVT triggers an inflammatory response subsequently injuring the vein wall.[6]

Deep vein thrombosis

.

Superficial vein thrombosis

Phlebitis

. This is a rare condition in which blood clots occur in the iliofemoral vein due to compression of the blood vessels in the leg. The specific problem is compression of the left common iliac vein by the overlying right common iliac artery. Many May-Thurner compressions are overlooked when there is no blood clot. More and more of them get nowadays diagnosed and treated (by stenting) due to advanced imaging techniques.[9]

May–Thurner syndrome

The most common cause of chronic venous insufficiency is reflux of the venous valves of superficial veins.[2] This may in turn be caused by several conditions:


Deep and superficial vein thrombosis may in turn be caused by thrombophilia, which is an increased propensity of forming blood clots.


Arteriovenous fistula (an abnormal connection or passageway between an artery and a vein) may cause chronic venous insufficiency even with working vein valves.

Management[edit]

Conservative[edit]

Conservative treatment of CVI in the leg involves symptomatic treatment and efforts to prevent the condition from getting worse instead of effecting a cure. This may include

Prognosis[edit]

CVI is not a benign disorder and, with its progression, can lead to morbidity. Venous ulcers are common and very difficult to treat. Chronic venous ulcers are painful and debilitating. Even with treatment, recurrences are common if venous hypertension persists. Nearly 60% develop phlebitis which often progresses to deep vein thrombosis in more than 50% of patients. The venous insufficiency can also lead to severe hemorrhage. Surgery for CVI remains unsatisfactory despite the availability of numerous procedures.[6]