Rajen's Easytips: CHRONIC VENOUS INSUFFICIENCY (CVI)

CHRONIC VENOUS INSUFFICIENCY

Chronic venous insufficiency (CVI) is no longer considered as an ordinary disease only affecting the elderly population.
CVI is now recognized as a serious and evolving pathology affecting a substantial proportion of the population.
CVI is a progressive disease and starts at a relatively young age, including a considerable percentage of the professionally active population.
Although generally affecting women, CVI also concerns the male population.
CVI has a disabling impact on the individual’s quality of life as it may impair the individual’s ability to work and even dominate his or her way of life.
Malfunctioning valves of the veins lead to venous reflux and ultimately varicose veins and venous leg ulcers.

1. Risk factors for developing CVI

2. Symptoms of CVI

Class 0 – pain, sensation of swelling, heavy legs, itching, cramps, no visible signs
Class 1 – telangiectasia or reticular veins (<1 mm diameter)
Class 2 – varicose veins (1-4 mm diameter)
Class 3 – edema
Class 4 – skin changes ascribed to venous disease, e.g. pigmentation, venus eczema, and lipodermatosclerosis
Class 5 – skin changes as defined in Class 4, with healed ulceration
Class 6 – skin changes as defined in Class 4, with active ulceration

3. Investigations in CVI

It is an apparatus combining a hemodynamic study (Doppler).
This investigation enables complete anatomical and hemodynamic study without limitation of the venous system of the lower limbs.
It is indicated in the investigation of varicose veins, and deep and superficial venous diseases, such as asthrombophlebitis and in postphlebitic disease.

In medicine, a Doppler apparatus uses a beam of ultrasound enabling measurement of blood velocity in vessels, and above all its direction: to the heart for normal venous flow and the feet for pathological venous reflux.

4. Treatment of CVI

Veins are injected with a substance (sclerosing liquid) which damages the inner layer of the vein, leading to an inflammatory reaction and finally destruction of the vein.

Oral phlebotropic drugs act on the veins covering all the three systems involved in CVI
Their absorption takes place in the small intestine through micronization
They increase the contractility of the veins thereby improving the circulation of venous blood
They improve the flow of lymphatics which means less swollen legs (edema)
They protect the smallest veins from being damaged, which means less edema and local inflammation and healing of the venous leg ulcers.

Phlebectomy is a surgical extraction of a part of a vein through a small incision of 1-2 cm.
Stripping by invagination is one of the several surgical techniques to remove large varicose veins.
Under local anaesthesia, a wire is inserted in the vein which enables it ot to be withdrawn by turning it inside out like the finger in a glove.
It can be done as an ambulatory procedure with the patient allowed to return home the same day.