Chronic venous insufficiency

According to the Bonn Vein Study*, roughly 3% of the German population suffers from chronic venous insufficiency (CVI). This condition, also frequently referred to as venous insufficiency, is not life-threatening but should not be downplayed. It poses a risk of serious long-term complications such as venous leg ulcers (ulcus cruris venosum), which means that affected legs absolutely require consistent treatment at an early stage.

Chronic venous insufficiency (CVI), also referred to as chronic venous congestion syndrome, is a disorder of the venous system. This condition impairs the return of blood to the heart. This can result in pathological changes to the blood vessels, the connective tissue and skin surface all the way to chronic wounds.

The principal cause for CVI is defective venous valves. The risk of suffering from chronic venous insufficiency is higher for women than for men and increases with age, excess weight and prior history of venous disorders.

The following risk factors increase the probability of developing chronic venous insufficiency (CVI):

Conditions that make CVI more likely to occur

The following conditions can make chronic venous insufficiency (CVI) more likely to occur: 
 

• Defective venous valves
• Venous inflammation
• Post-thrombotic syndrome (PTS) as a consequence of vein thrombosis
• Genetically inherited blood clotting disorders
• Infections
• Pelvic tumours
• Superficial thrombophlebitis
• Acute leg trauma
• Arterio-venous fistulas
• Vascular malformations such as congenital venous valve damage (venous angiodysplasia)
• Hyperhomocysteinemia 

Based on the typical symptoms, such as the skin changes described above, chronic venous insufficiency can usually be detected easily with the naked eye. If more extensive diagnostics are required, this is generally carried out using duplex ultrasound. This special ultrasound device shows the compression ratio in the blood vessels and produces images of changes in the vascular walls.

Phlebography involves injecting a contrast agent into the bloodstream to visualize the contours of the blood vessels in the X-ray image. In pressure phlebography, the superficial veins are tied off to obtain a clearer picture of blood flow through the deep leg veins.

Although many factors involved in chronic venous insufficiency (CVI) are hereditary, there are some preventive steps you can take. The most important activities to prevent chronic venous insufficiency are movement and wearing compression garments. But individual lifestyle also plays a role.

• Preventative wearing of compression stockings
• Lots of movement as part of everyday activities
• Regular endurance sport (swimming, walking etc.)
• Vein exercises
• Avoiding long periods of sitting and standing
• Avoiding severe heat, such as in a sauna or hot baths
• Cold showers and treading water
• No constricting clothing
• Give up alcohol and nicotine
• Healthy diet and losing excess weight 

To prevent changes and injuries to the skin, attentive skin care is also required for cases of venous insufficiency. Use PH-neutral cleaning products and lipid replenishing skincare products with 5 to 10% urea.

The goal of treatment for CVI is to improve the circulation and prevent blood congestion. Wearing compression stockings is the most important element of conservative therapy. Compression stockings gently press the veins in so that the venous valves are closer together and better able to shut. The flow speed and thereby the return flow of venous blood is promoted.  

Medication-based treatment of CVI is dependent on the concomitant circumstances of the condition. If there is a risk that a blood clot could form (thrombosis), medicines that slow blood clotting (anticoagulants) are used. For severe swelling caused by excess fluids, drugs that get rid of excess water (diuretics) are used to promote urine elimination.  

If a wound has already formed that no longer heals itself, you should absolutely seek medical assistance and request information about treatment for venous leg ulcers (ulcus cruris venosum).

Depending on the cause of CVI, surgery may be required. For example, in patients with pronounced varicose veins, surgical sclerosis or complete removal (stripping) of the severely bulging blood vessels during a vein operation may be helpful. Afterwards, intact parts of the venous system resume their function and the blood flow improves. However, long-term treatment with compression generally remains necessary and beneficial even after vein surgery.

Complete healing of CVI is not possible, as damaged veins are unable to fully regenerate. In advanced stages, apart from spider veins and varicose veins, discolouration of the skin also remains visible.

Chronic wounds such as venous leg ulcers can heal. Because this type of wound forms from the interior towards the exterior, there is a major risk that a wound will occur again. This is because the formation of a thin, closed layer of skin is just the first step of the healing process.

For this reason, compression stockings should be worn consistently and on the long term in cases of chronic venous insufficiency.