Treating CVI with Evidence-Based Guidelines
If you notice aching, swollen legs that just won’t seem to improve, you may be dealing with chronic venous insufficiency (CVI). This frustrating condition affects over 30 million adults in the United States alone.
Thankfully, with the right chronic venous insufficiency treatment guidelines (here’s a comprehensive pdf on the condition), you can minimize discomfort and reduce complications.
At Vein Center Doctor, we offer customized vein treatments tailored to your needs. Contact us today so we can provide a solution to your CVI.
Understanding Chronic Venous Insufficiency (CVI)
CVI develops when the one-way valves inside your leg veins stop working properly. These valves are supposed to keep blood flowing up towards the heart. When they become damaged, blood starts flowing backwards and collects inside the veins. This results in venous hypertension, or abnormally high pressure inside the veins.
Over time, the high pressure causes vein walls to stretch and lose elasticity. Blood starts pooling inside the veins instead of flowing back to the heart.
As CVI advances, the veins become swollen, twisted, and visibly varicose. Patients experience a number of frustrating symptoms as a result.
Symptoms of Chronic Venous Insufficiency
In the early stages of CVI, people may not experience any noticeable symptoms. As the condition progresses, common signs and symptoms include:
- Aching, heavy, tired legs, especially after prolonged standing or sitting
- Throbbing, muscle cramping, or burning sensations in the lower legs
- Swelling in the ankles and feet (edema)
- Visible varicose veins just under the skin surface
- Discolored brownish skin and darkened pigmentation around the ankles
- Restless leg syndrome, especially at night
- Itching and irritation around varicose veins
Without proper treatment, CVI symptoms often worsen over time. Roughly 15-20% of patients can develop advanced CVI complications like:
- Venous ulcers – open sores on the lower legs and ankles
- Bleeding from varicose veins
- Superficial thrombophlebitis – inflamed, blood clot-filled veins
- Skin thickening or hardening around the ankles (lipodermatosclerosis)
- Cellulitis – a serious bacterial skin infection
Clearly, living with poorly controlled CVI can majorly impact your mobility, comfort, and quality of life. Seeking appropriate diagnosis and following chronic venous insufficiency treatment guidelines is crucial to managing symptoms and avoiding complications.
Diagnosing Chronic Venous Insufficiency
The first step is to make an appointment with a vein specialist for a thorough diagnostic evaluation. Your doctor will review your signs and symptoms, medical history, and risk factors.
They may also examine your legs visually to look for visible varicose veins and skin changes.
Some common diagnostic tests used to evaluate chronic venous insufficiency include:
- Duplex ultrasound – This specialized ultrasound examines the veins in your legs and looks for blood flow problems, leaking valves, blood clots, and blockages. It can also measure the speed of blood flow.
- Plethysmography – This test measures leg vein function at rest and after exercise. It helps determine if and where blood may be pooling in your leg veins.
- CT scan – Advanced CT imaging provides detailed 3D pictures of the veins in your legs. It can detect varicose veins and identify the underlying cause.
- Venography – This involves injecting a contrast dye into the leg veins and taking X-ray images to visualize vein damage and blood flow issues.
Based on your test results and clinical exam, your vein doctor can determine the extent of your CVI, classify it into a CEAP grade, and recommend appropriate treatment as per chronic venous insufficiency treatment guidelines.
CEAP Classification for Chronic Venous Insufficiency
The CEAP classification system is universally used to grade the severity of chronic venous insufficiency. It has four components:
- C – Clinical signs and symptoms, from minor (C0) to advanced skin changes (C6)
- E – Etiology or underlying cause – congenital, primary, or secondary
- A – Anatomic distribution – superficial, deep, or perforator veins
- P – Pathophysiology – reflux, obstruction, etc.
Knowing your CEAP grade helps guide treatment. For example, mild CVI with minimal symptoms can be treated conservatively, while advanced disease requires interventional treatments.
Guideline-Recommended Treatments for Chronic Venous Insufficiency
Several medical societies have published clinical guidelines for chronic venous insufficiency treatment including the American Venous Forum, American College of Phlebology, and Society for Vascular Surgery. The goals of treatment are to:
- Alleviate aching, pain, cramping, and other symptoms
- Reduce leg swelling
- Prevent skin damage and ulcers
- Improve overall function and quality of life
Treatment options include:
Conservative Therapies
In the early stages of CVI, conservative management may be sufficient to control mild symptoms. This includes:
- Compression stockings – Prescription gradient compression stockings worn daily help improve venous circulation and reduce swelling. They come in different compression strengths.
- Leg elevation – Keeping your legs raised above heart level several times a day utilizes gravity to drain excess fluid from the veins.
- Exercise – Light physical activity like walking, swimming, or cycling helps activate the leg muscle pump and venous blood flow.
- Weight loss – Losing excess weight reduces pressure on the vein valves.
- NSAIDs – Over-the-counter non-steroidal anti-inflammatory drugs like ibuprofen help temporarily reduce CVI pain and inflammation.
Medical Therapies
Your doctor may recommend medical therapies in conjunction with conservative treatment of CVI:
- Venoactive drugs – These oral medications such as diosmin and hesperidin help tone vein walls, reduce swelling, and improve blood flow.
- Blood thinners – Drugs like low molecular weight heparin or warfarin prevent blood clot formation in varicose veins.
- Antibiotics – May be prescribed to treat cellulitis infections associated with advanced CVI.
Interventional Treatments
When conservative measures prove inadequate to control progression of CVI, interventional treatments are often necessary. Modern minimally invasive techniques are highly effective at improving blood flow, symptoms, and appearance of varicose veins.
- Endovenous thermal ablation – Heated radiofrequency or laser energy is used to collapse and seal off damaged varicose veins.
- Vein stripping – Removal of superficial varicose veins through tiny incisions using local anesthesia.
- Sclerotherapy – Injection of a chemical irritant directly into spider veins and varicosities to scar and close them off.
- Embolization – Direct injection of a special adhesive or foam agent into varicose veins to seal them shut.
- Stenting – Insertion of small mesh tubes called stents to prop open obstructed veins.
Surgical Treatment
If you have advanced CVI with major venous blockages, your doctor may recommend vascular surgery such as:
- Vein bypass – Grafting a vein from another part of your body to reroute blood flow around blocked leg veins.
- Valve transplants – Surgically implanting a healthy vein valve.
- Vein ligation and stripping – Surgically removing the saphenous vein.
Get Prompt Chronic Venous Insufficiency Treatment at Vein Center Doctor
Don’t let chronic venous insufficiency impact your quality of life any longer.
As leading vein specialists serving New York and New Jersey, we follow accepted CVI treatment guidelines to provide prompt, effective relief from your symptoms. With a combination of conservative therapies, minimally invasive procedures, and advanced treatments, our goal is to help you achieve healthy, pain-free legs.
Schedule a visit at our conveniently located vein clinics in Clifton, NJ and Ardsley, NY. We offer personalized care plans tailored to your specific chronic venous insufficiency diagnosis and goals.
