Chronic Venous Insufficiency (CVI) is a condition in which blood pools in the veins, causing stress in the walls of the vein. Veins carry non-oxygenated blood from the legs and other organs back to the heart. To reach the heart the blood needs to flow upward from the veins in the legs. The muscles in the calves need to contract with each step to squeeze the veins and push blood towards the heart. Veins contain one-way valves and when these valves are diseased or malfunctioning, the blood cannot move through and pools in the legs.
Risk Factors and Symptoms of CVI
An estimated 40% of people in the United States have CVI. It occurs more frequently in women and those over age 50. Other risk factors include:
- Prior history of blood clots
- Varicose veins
- Obesity
- Smoking
- Family history
- Prolonged sitting or standing
Symptoms Include:
- Edema -- swelling in the legs and/or ankles that may cause tightness
- Leg pain -- throbbing or aching leg pain that worsens when standing
- Pruritus -- itching in the legs
- Skin changes -- thickening of the skin or color changes on legs and/or ankles
- Stasis ulcers -- non-healing wounds or ulcers on the feet, legs, or ankles
- New varicose veins
Diagnosis of CVI:
Diagnosis can be made upon a detailed physical exam and a complete medical history. A variety of imaging can be utilized to confirm a diagnosis of CVI:
- Ultrasound -- speed and direction of blood flow can be determined using ultrasound
- Venogram -- small intravenous catheter (IV) is placed into the hand or foot and x-ray contrast is injected
Treatment of CVI:
The treatment for CVI depends on many factors. These include the cause of the condition and your medical history and current health status.
The most common treatment for venous insufficiency is prescription compression stockings. These stockings apply pressure at the ankle and lower leg to improve blood flow and can reduce leg swelling.
Medications such as diuretics that draw extra fluid from your body, blood thinner, and medications which help improve blood flow.
Historically, CVI was treated with open surgical procedures. In recent years, minimally-invasive treatments have developed. The Interventional Radiologists at Pennsylvania Vascular Institute specialize in these modern medical techniques.
Other Venous diseases
Varicose Veins & Spider Veins
Varicose veins are enlarged and twisted blood vessels that are close to the skin surface. Conservative therapy is typically considered first when treating varicose veins. When conservative treatment fails, the clinicians at PVI are skilled in the following advanced treatments:
- Sclerotherapy -- used in the treatment of small to medium-sized varicose veins; a pharmaceutical agent is injected which cases the scarring and closes the vein. The body will reroute blood to healthier veins (collateral veins). The veins disappear within a few weeks. The procedure takes approximately 1 hour with a short recovery.
- Venous Ablation -- Using a tiny wire placed into the vein, heat is applied by radio-frequency or laser. This heat will cause scarring of the inside of the vein and force the vein to close-off. The body will then redirect blood to collateral veins.
Chronic Venous Occlusion (CVO)
CVO is usually caused by a clot in a deep vein, known as deep vein thrombosis (DVT). Treatment with blood thinners can dissolve the clot. Left untreated, the clot may cause scar tissue to develop inside the vein leading to a blockage. advances in medicine has allowed for minimally-invasive procedures to treat such venous diseases:
- Angioplasty -- a thin catheter is placed into the blood vessel and a balloon is inflated to open the blockage
- Stent Placement -- a mesh tube is permanently inserted into the diseased vessel to hold the blockage open
Non-Thrombotic Iliac Vein Lesion (NIVL)/May-Thurner Syndrome
NIVL, also known as May-Thurner Syndrome is caused by compression of the left iliac vein by the right iliac artery. The disease causes blood to pool in the leg veins and this pooling can cause clots to form. Symptoms of NIVL include:
- Left leg pain
- Swelling
- Tenderness
The treatment for May-Thurner syndrome is much like the treatment for other venous and arterial diseases where narrowing and clotting is involved. A venogram will show the area of narrowing and a stent is placed, which permanently holds the vein open. More recently the development of Intravascular Ultrasound (IVUS) has allowed Interventional Radiologists to view the condition from inside the blood vessel.
Pennsylvania Vascular Institute is pleased to provide you with diagnostic and treatment options for patients suffering from venous disease.