What is chronic venous insufficiency?

Chronic venous insufficiency (CVI) is a problem that happens when the muscles, veins, and valves in your legs lose their ability to return blood back to your heart the way they used to. It causes blood to collect, or “pool,” in the veins. The pressure from the blood can cause the smallest blood vessels to break, which can lead to sores on your legs. Once it develops, CVI is a lifelong condition.

What is the cause?

When the muscles in your feet and legs tighten and relax, they help to return blood to your heart. To help this process, the veins have a series of one-way valves in them. The valves open as blood flows toward your heart and then close to prevent blood from flowing backward toward your feet. Problems with your leg veins, with valves, or with muscles can keep the blood from moving up toward your heart.

Getting older, being inactive, or being overweight can weaken or damage the valves in your veins and cause CVI. Health problems which cause frequent swelling in your legs and feet can also cause CVI over time. Valve damage can also happen if you have had a tumor or blood clot in your leg. Some people may be born with weak valves. Weak valves run in some families.

What are the symptoms?

Symptoms may include:

• Swelling in your legs or ankles
• A dull ache, tiredness, or heaviness in your legs, especially after standing for a long time
• Leathery skin texture and leg tissue that feels hard when you touch it
• Flaking and itching of the skin on your legs and feet
• Sores on your skin, usually above the ankle

People with CVI may also have varicose veins. Varicose veins are enlarged veins close to the surface of the skin.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• IPG (impedance plethysmogram), which uses a pressure cuff on your arm or leg to measure blood flow in the veins of the arm or leg
• Ultrasound, which uses sound waves to show pictures of the veins in your arm or leg
• A contrast venogram, which uses X-rays and a dye injected into a vein to show any blockages in your veins

How is it treated?

The goals of treatment are to keep the blood from moving up toward your heart and to prevent sores.

• If you do not have any sores and there is no fluid oozing out of the tissue, your provider may recommend:
  • Nonprescription hydrocortisone cream to help with itching, redness, and swelling
  • Creams such as zinc oxide to help protect your skin from cracking and getting infected
  • An antifungal cream to help prevent fungal infection.
• If your skin is oozing fluid, your healthcare provider may recommend wet compresses with a nonprescription antibacterial solution that you can buy at most drug stores. Your provider will show you how to use the compresses, and tell you how long to use them.
• Sores are treated with layered compression bandages. Your healthcare provider can teach you how to put on the 3 or 4 layers of different types of bandages. Elastic bandages are not used because they do not provide enough pressure.
• If the sores are infected, your provider may prescribe antibiotics.
• To help the blood in your legs to flow to your heart, raise your legs above the level of your heart at set times throughout the day (at least 30 minutes every 2 hours). At night, sleep with your feet raised about 6 inches by propping them on pillows.
• Compression stockings can decrease pressure in the veins and prevent sores. These stockings are different from the elastic stockings that may be used to treat a blood clot. They are specially made to fit each person so that they put the most pressure near the ankles and the least pressure near the knees. You should put the stockings on after your legs have been raised for a time, such as before you get out of bed in the morning.

If these methods do not provide relief, your healthcare provider may recommend one of these types of surgery:

• Sclerotherapy, which uses an irritating liquid injected into the veins. This causes the veins to close and forces the blood to flow through healthier veins. This procedure may decrease the swelling and make your legs look better. Injections may be done in a healthcare provider’s office. Several treatments may be needed. There is a risk of scarring and blood clots with this treatment.
• Vein ligation and stripping, which is surgery to tie off and sometimes remove parts of veins
• Valvuloplasty, which is surgery to repair the valves in your veins

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Keep your legs raised when you are in bed or sitting down. Keeping your legs up helps the return of blood from the leg veins.
• Avoid sitting or standing for long periods of time. When you are traveling, move your feet and legs often. Go for short walks if possible at least every 1 to 2 hours.
• Avoid crossing your legs and ankles when you sit.
• Exercise as recommended by your healthcare provider.
• Avoid wearing control-top pantyhose, leg garters, and other tight-fitting garments.
• Keep a healthy weight. If you are overweight, try to lose some weight.
• Stop smoking. Smoking increases the risk for blood clots.
• Wear support hose or special stockings as prescribed by your healthcare provider. Make sure you know how to wear them correctly.
• Protect your feet and legs from injury, for example, by wearing comfortable, supportive shoes and socks. Keep the floors of your living area free from fall hazards, such as slippery throw rugs and toys.
• Keep your skin clean, dry, and soft. Wash with a mild soap, dry carefully and thoroughly, and put an unscented lotion on your legs right away if dryness has been a problem.

Ask your provider:

• How and when you will hear your test results
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent chronic venous insufficiency?

• Exercise regularly to help you keep good muscle tone, good blood flow, and a healthy weight.
• If you have a family history of varicose veins, talk with your healthcare provider about what you can do to try to prevent problems with your veins.