Chronic Venous Insufficiency (CVI) is one of the leading causes of swollen feet, ankles and legs.
- Someone with CVI may experience:
- Ankle swelling
- Tight feeling calves
- Heavy, tired, restless or achy legs
- Pain while walking or shortly after stopping
There are several things that can cause CVI. Ultimately, long-term blood pressure in the leg veins that is higher than normal can causes CVI. If the valves in the veins are damaged blood can pool in the lower extremities and cause varicose veins. Sitting or standing can stretch the superficial vein walls and damage the valves in the veins which keep blood from flowing back down the legs.
DVT happens when a blood clot (thrombus) blocks the blood flow back to the heart out of the deep veins or perforating veins, which connect the deep veins to the superficial veins. Deep vein thrombosis (dvt) can also cause CVI, because it blocks the flow of blood back to the heart and elevates the pressure inside the veins.
- Factors that increase your risk of CVI include:
- Family history of varicose veins
- Being overweight
- Not exercising enough
- Being pregnant
- Sitting or standing for long periods of time
CVI can be diagnosed by your physician by taking your patient history and physical exam. The physician may also measure the blood pressure in your legs and examine any varicose veins you may have. To confirm a diagnosis of CVI, the physician will usually order a duplex ultrasound or a venogram. A duplex ultrasound uses sound waves to measure the speed of blood flow and visualizes the structure of the leg veins. A venogram is an x-ray that uses a dye (contrast) which enables the physician to see the veins.
Chronic venous insufficiency is usually not considered a health risk; your physician will try to decrease your pain and disability. In mild cases of CVI, compression stockings or compression socks may alleviate the discomfort and swelling. Physicians usually use a 20-30mmHg compression stocking or a 20-30mmHg compression sock for this. The stockings will not make the varicosities go away, but is the least invasive treatment.
More serious cases may require sclerotherapy, ablation, or surgical intervention such as stripping to correct the problematic vein. This is usually done by a vascular specialist or vascular surgeon. During sclerotherapy a chemical is injected in the affected vein or veins and a scar will form from the inside of the vein. During ablation a thin, flexible tube (catheter) with an electrode at the tip will heat the vein walls at the appropriate location to seal the vein. When a vein stripping is done one of the saphenous veins is removed. The physician will make a small incision in the groin area and usually another in the calf below the knee. The veins associated with the saphenous vein will be disconnected and tied off and the vein removed. There are other surgical procedures which are done to improve your leg health. After one of the above procedures 20-30mmHg compression stockings are usually put on and you are told to wear them for a certain length of time. Some physicians will tell their patients on their follow-up visit that it is no longer necessary to wear the compression garments. For me, this is where I have some concerns. If the real underlining cause of CVI (such as family history of varicose veins, being overweight, not exercising enough, smoking or sitting or standing for long periods of time) has not been corrected why would you not continue to wear compression stockings to keep from developing CVI again.
Compression stockings and socks have come a long way in the last few years. They no longer look like the garments our grandparents wore. They look like ordinary stockings and socks. The stigma of wearing compression garments is past.
Here’s to feet, ankles, and legs that are no longer swollen,