Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is a common medical problem occurring in a leg vein and leading to increasing pain and disability. It is caused either by superficial (severe varicose veins) or deep (after deep vein thrombosis) venous pathology and characterized by an increased venous pressure during walking. CVI damages valves in the veins of the legs due to injury, blood clots, or a congenital weakness of the valves raising the pressure in the deep veins of the leg significantly. The result is constant swelling, chronic pain, varicose veins and a progressive degeneration and thickening of the skin near the ankle which leads, ultimately, to serious and virtually incurable ulcers. In the worst cases, these ulcers can become infected, gangrene can set in and amputation may be required to save the patient's life. Chronic venous insufficiency occurs in 10%-15% of men and 20%-25% of women. At least two-thirds of leg ulcers have evidence of venous disease in the affected limb.

The main symptoms are pain, swelling of the leg, pigmentation in the ankle area, indurations of skin and even skin breakdown with overt ulceration. The non-invasive assessment is a must in these extreme cases.

People affected by chronic venous insufficiency should not sit or stand for long periods of time and when sitting should elevate their legs. Walking helps increase venous blood flow and reduce pooling. Wearing tight-fitting compression stockings available from pharmacies further supports the veins. To allow pooled blood to drain, raise the legs above the level of your heart at set times throughout the day. At night, sleep with the feet elevated about 6 inches by propping them on pillows.

The legs have two separate systems of veins through which blood makes its return trip to the heart. The first system, deep within the leg, carries blood at a higher pressure than do the superficial veins closer to the skin. In order to reduce the pumping force needed to return blood to the heart, veins contain valves, which allow the blood to move easily upward toward the heart, but prevent it from flowing backward between pumping phases of the heartbeat. CVI results from failure of the valves in deep or superficial veins. The valves in the veins may have been damaged by a blood clot in one of the deep veins of the leg. When these valves are not working well, the blood has difficulty moving upward. Prolonged increased pressure in the veins causes the valves to stretch out, making them unable to close properly. As a result, the blood flows back into other veins and pools in the tissues of the legs, causing swelling. In addition to blood clots, obesity, inactivity, and aging can contribute to the weakening of or damage to the valves. Some people may have just inherited weak valves.

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Follow a high-fiber, whole-foods diet with plenty of raw vegetables and fruits.

Massage your legs starting with the feet and moving up to the groin with castor oil, especially after a bath or shower. Get adequate exercise for your body by walking. The goals of treatment are to reduce the pooling of blood and prevent ulcers. The clot itself usually will resolve through the natural healing processes. Treatment is also aimed at relieving symptoms and preventing the clot from traveling to the lungs, heart, brain, or other areas. The usual treatment in the early stages of CVI is elastic stocking to apply external pressure to the system and dressings and salves to treat the ulcers. The only treatment for advanced stages of the disease was surgery to tie off the perforator veins to relieve the pressure in the superficial system -- pressure patients describe as making the leg feel like it is about to explode. Anticoagulants such as heparin or warfarin or antiplatelet medications such as aspirin are prescribed to prevent further clotting. Analgesics may be needed to control pain. Vascular surgeons either repair damaged valves in the large veins of the upper leg, or bypass them using a length of vein with healthy valves from somewhere else in the body. Only one or two key valves must be restored to normal function to return pressures in the system to normal.

Tight clothing, especially jeans, knee socks, snug fitting boots or waist-cinching belts, not only contribute to bad circulation but also to stress. To avoid stress, meditation, prayer or other methods of unwinding and relaxing are advisable.