Chronic Venous Insufficiency (CVI)
CVI occurs when venous valves in the legs fail, causing blood pooling, venous hypertension, leg swelling, skin changes, and ulcers. Risk increases with age, obesity, prolonged standing, pregnancy, and history of DVT.
Symptoms & CEAP Classification
- Leg heaviness, aching, throbbing, burning
- Swelling (edema), worse by end of day
- Varicose veins, telangiectasias
- Skin changes: hyperpigmentation, eczema, lipodermatosclerosis
- Venous ulcers near medial malleolus
- CEAP staging (C0–C6) guides severity
Diagnosis
- Clinical exam (standing) to assess veins, edema, skin changes
- Duplex ultrasound to evaluate venous reflux and obstruction
- Photoplethysmography or venography (less common)
- Rule out arterial disease (ABI) before compression therapy
Treatment & Management
Conservative Measures
- Graduated compression stockings (20–30 mmHg or higher), don daily
- Leg elevation above heart, ankle pumping exercises
- Maintain healthy weight, regular walking
- Avoid prolonged sitting/standing; take movement breaks
- Skin care with emollients; treat stasis dermatitis with topical steroids
Medications
- Venoactive drugs (horse chestnut seed extract, diosmin/hesperidin) may reduce symptoms
- Diuretics only for concurrent heart failure; not routine for CVI
Interventional Options
- Endovenous thermal ablation (radiofrequency or laser) for refluxing saphenous veins
- Ultrasound-guided foam sclerotherapy for tributaries/varicosities
- Mechanochemical ablation, glue closure, or stripping (less common now)
- Perforator vein ablation or iliac stenting for complex cases
Venous Ulcer Management
- Multilayer compression wraps, wound dressings, debridement
- Negative pressure therapy, bioengineered skin substitutes when needed
- Treat infection if present; ensure adequate arterial inflow
Living with CVI
- Track edema, pain, skin changes, ulcer dimensions, compression use
- Schedule regular breaks to elevate legs, especially at work
- Use compression devices (intermittent pneumatic compression) for severe cases
- Monitor for DVT signs (calf pain, sudden swelling)
- Mental health support; leg appearance and chronic ulcers affect self-esteem
Complications
- Venous ulcers, cellulitis
- Superficial thrombophlebitis, DVT/PE
- Progressive skin fibrosis, mobility limitations
Research & Future Directions
Innovations include bioabsorbable valves, regenerative tissue dressings, and wearables that monitor edema/compression adherence.
Experimental & Emerging Treatments
- Implantable Venous Valves: Bioengineered devices aim to restore valve competence in deep veins.
- Growth Factor & Stem Cell Dressings: Encourage faster venous ulcer healing.
- Smart Compression Systems: Sensors track pressure dosing and patient adherence.
- Digital Twins for Venous Flow: Imaging + AI to optimize ablation targets and predict ulcer recurrence.
Track CVI with Diagnoza.care
Lighten Your Legs – Log compression hours, edema measurements, pain scores, ulcer progress photos, procedures, wound clinic visits, medications, and activity levels; capture side effects; and let the AI companion remind you to elevate, hydrate, and follow up.
Medical Disclaimer: Informational only. Work with your vascular specialist or wound care team for individualized compression, procedural decisions, and ulcer management.
Sources: Society for Vascular Surgery, American Venous Forum, European Society for Vascular Surgery