Chronic venous insufficiency (CVI) - also known as chronic venous insufficiency or venous insufficiency - is a venous disease in which the patient's lower legs are insufficiently supplied with blood. This leads to pathological changes in the blood vessels, connective tissue and skin surface. Chronic venous insufficiency mainly affects women.
Below you will find further information and selected specialists for chronic venous insufficiency.
Chronic venous insufficiency (CVI) is a disease of the leg veins in which the patient's lower legs are insufficiently supplied with blood. The reason is usually a congestion of the blood transport, which leads to increasing swelling of the tissue. The deep veins are usually affected, but in some cases the superficial veins are also affected. The veins dilate, the venous valves in them are leaky and the deoxygenated blood can no longer drain away properly.
This results in pathological changes to the connective tissue and the surface of the skin.
These are manifested by
Oedema occurs when lymph fluid builds up and can no longer drain properly @ toa555 / AdobestockAlso known as chronic venous insufficiency or venous insufficiency, this condition mainly affects women. Although it is not life-threatening, you should not trivialize it. This is because you will need long-term treatment for the affected leg.
The main cause of chronic venous insufficiency is defective venous valves. They can no longer or only insufficiently fulfill their function. If they no longer close properly, the venous blood flows back into the lower legs instead of to the heart. This then leads to congestion.
This results in high blood pressure in the superficial veins: Instead of the normal 20-30 millimeters of mercury (mmHg), it is 60-90 mmHg. This abnormally high venous pressure usually leads to venous thrombosis. Patients are also prone to varicose veins due to a hereditary tendency.
Venous thrombosis leads to increased pressure in the deep veins of the legs. This damages the venous valves and the walls of the blood vessels. The accumulated blood causes the blood vessels to dilate excessively, resulting in the formation of spider veins. Varicose veins develop when larger vessels are damaged.
Why does chronic venous insufficiency cause skin damage?
The blood vessels become permeable, causing blood cells and fluid to leak into the neighboring tissue. This leads to chronic inflammation with hardened connective tissue and thickened subcutaneous cells. The skin no longer receives sufficient oxygen and nutrients as the metabolism between the skin surface and the arteries is disturbed.
This results in skin damage due to infections and allergic reactions. The upper layer of the skin hardens and forms eczema (rashes) even with minor injuries. If it is not treated in time, it can develop into an open leg (leg ulcer). It occurs preferably in the area of the inner ankle over varicose veins or over damaged venous valves.
As the patient experiences severe pain with an open leg, they adopt a protective posture and move less often. This often leads to stiffening of the upper ankle joint.
What are the risk factors for developing chronic venous insufficiency?
Patients with chronic venous insufficiency are at increased risk:
Experts divide chronic venous insufficiency into three degrees of severity:
Further symptoms of chronic venous insufficiency are
Patients who experience one or more of these symptoms should seek specialist treatment. A specialist in vascular surgery or a phlebologist (specialist in venous diseases) is responsible for this.
Chronic venous insufficiency can be easily recognized with the naked eye . The examining doctor obtains further information during duplex sonography (Doppler sonography). Doppler sonography is a special ultrasound device that provides information about the pressure conditions in the blood vessels. It also reveals changes in the vessel walls and surrounding tissue.
To support the treatment of venous insufficiency, daily physical exercise and elevating the legs in bed at night are recommended. It is sufficient to walk for 30 minutes a day in comfortable shoes. This also applies to CVI patients with open legs.
Lighter cases of CVI can be improved with symptomatic therapy. It often helps to elevate the patient's legs several times a day for half an hour at a time . This improves the blood circulation in the tissue and existing swelling (oedema) is reduced.
If this is not enough, the next step is compression therapy. This involves regular manual lymphatic drainage or compression stockings. The physiotherapist uses manual movements to promote the drainage of the lymph that has accumulated in the tissue. This can then be excreted by the kidneys.
The compression stockings are so tight that they slightly compress the veins. This leads to a reduction in oedema and supports the return flow of venous blood to the heart. The functionality of the venous valves improves. The patient no longer has the feeling of suffering from "heavy legs".
Medical compression garments are stockings, tights or arm warmers @ tibanna79 /AdobeStock
People with severely damaged venous valves must wear compression stockings for the rest of their lives, otherwise the open leg will recur.
What medications are available?
Doctors use pain-relieving and anti-inflammatory drugs such as ibuprofen to treat CVI with medication. Although these medications do not eliminate the cause, they do alleviate the symptoms.
Wound dressings with horse chestnut extract ointment can also help to alleviate chronic venous insufficiency. Weeping congestive eczema is treated with compresses containing oak bark extract from the pharmacy.
Open legs can be treated well with iodine-based antiseptic ointments and polyurethane wound dressings.
What surgical procedures are available?
For patients with severe varicose veins, varicose vein sclerotherapy or complete removal of the protruding blood vessels can help. This usually takes the form of vein surgery. This also normalizes the venous blood flow.
If the affected person suffers from poorly healing ulcers, doctors surgically remove the damaged area of skin (shave procedure). They then sew on a split-thickness skin graft.
For the split-thickness skin graft, doctors use a 0.3 mm thick piece of skin from the patient's thigh. A special device can then stretch it into a mesh. This allows the wound to heal more quickly.
Doctors use fascia (connective tissue) surgery to free constricted arteries and leg muscles as well as hardened tissue cells. The aim is to improve blood flow to the affected skin region and supply it with urgently needed nutrients.
To prevent chronic venous insufficiency from developing in the first place, you should be physically active as often as possible.
Well suited are
It is also advisable to reduce or avoid being overweight by eating a healthy and varied diet.
In the case of varicose vein disease with increasing leg swelling, it is advisable to have the diseased veins removed or sclerosed by surgery.
Patients with thrombosis should take blood thinning medication for a period of 3 to 6 months (or longer). They should also wear compression stockings for 1 to 2 years. Even after this period has elapsed, you should wear compression stockings and use thrombosis injections in stressful situations such as long flights.
