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ORIGINAL ARTICLE | https://my.clevelandclinic.org/health/articles/chronic-venous-insuf ciency

DATE P UBLISHED | March 16, 2017
HEALTH LIBRARY | ARTICLES | CHRONIC VENOUS INSUFFICIENCY (CVI)

Chronic Venous Insu ciency (CVI)

OVERVIEW | SYMP TOMS & DIAGNOSIS | TREATMENT OPTIONS | DOCTORS WHO TREAT | RESOURCES &

PATIENT INFO

What is chronic venous insu ciency (CVI)?

Chronic venous insuf ciency (CVI) is a condition that occurs when the venous wall and/or valves in the leg veins are not
working effectively, making it dif cult for blood to return to the heart from the legs. CVI causes blood to pool or collect
in these veins, and this pooling is called stasis.

Valve Inside Vein

What causes chronic venous insu ciency?

Veins return blood to the heart from all the bodys organs. To reach the heart, the blood needs to ow upward from the
veins in the legs. Calf muscles and the muscles in the feet need to contract with each step to squeeze the veins and push
the blood upward. To keep the blood owing up, and not back down, the veins contain one-way valves.

Chronic venous insuf ciency occurs when these valves become damaged, allowing the blood to leak backward. Valve
damage may occur as the result of aging, extended sitting or standing or a combination of aging and reduced mobility.
When the veins and valves are weakened to the point where it is dif cult for the blood to ow up to the heart, blood
pressure in the veins stays elevated for long periods of time, leading to CVI.

CVI most commonly occurs as the result of a blood clot in the deep veins of the legs, a disease known as deep vein
thrombosis (DVT). CVI also results from pelvic tumors and vascular malformations, and sometimes occurs for unknown
reasons. Failure of the valves in leg veins to hold blood against gravity leads to sluggish movement of blood out of the
veins, resulting in swollen legs.
Chronic venous insuf ciency that develops as a result of DVT is also known as post-thrombotic syndrome. As many as 30
percent of people with DVT will develop this problem within 10 years after diagnosis.

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What are the risk factors for chronic venous insu ciency?

If you have risk factors for CVI, you are more likely than other people to develop the disease. The most important risk
factors are:

Deep vein thrombosis (DVT)

Varicose veins or a family history of varicose veins
Obesity
Pregnancy
Inactivity
Smoking
Extended periods of standing or sitting
Female sex
Age over 50

Who is a ected by chronic venous insu ciency?

An estimated 40 percent of people in the United States have CVI. It occurs more frequently in people over age 50, and
more often in women than in men.

Reviewed: 12/15

Chronic Venous Insu ciency (CVI): Symptoms & Diagnosis

What are the symptoms of chronic venous insuf ciency?

The seriousness of CVI, along with the complexities of treatment, increase as the disease progresses. Thats why it is very
important to see your doctor if you have any of the symptoms of CVI. The problem will not go away if you wait, and the
earlier it is diagnosed and treated, the better your chances of preventing serious complications.

Symptoms include:

Swelling in the lower legs and ankles, especially after extended periods of standing
Aching or tiredness in the legs
New varicose veins
Leathery-looking skin on the legs
Flaking or itching skin on the legs or feet
Stasis ulcers (or venous stasis ulcers)

If CVI is not treated, the pressure and swelling increase until the tiniest blood vessels in the legs (capillaries) burst. When
this happens, the overlying skin takes on a reddish-brown color and is very sensitive to being broken if bumped or
scratched.

At the least, burst capillaries can cause local tissue in ammation and internal tissue damage. At worst, this leads to ulcers,

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open sores on the skin surface. These venous stasis ulcers can be dif cult to heal and can become infected. When the
infection is not controlled, it can spread to surrounding tissue, a condition known as cellulitis.

Vascular Ultrasound

CVI is often associated with varicose veins, which are twisted, enlarged veins close to the surface of the skin. They can
occur almost anywhere, but most commonly occur in the legs.

How is CVI diagnosed?

To diagnose CVI, your doctor will perform a complete medical history and physical exam. During the physical exam, the
doctor will carefully examine your legs.

A test called a vascular or duplex ultrasound may be used to examine the blood circulation in your legs. During the
vascular ultrasound (services/heart/diagnostics-testing/ultrasound-tests/vascular-ultrasound), a transducer (small hand-
held device) is placed on the skin over the vein to be examined. The transducer emits sound waves that bounce off the
vein. These sound waves are recorded, and an image of the vessel is created and displayed on a monitor.

Reviewed: 12/15

Chronic Venous Insu ciency (CVI): Treatment Options

How is chronic venous insu ciency treated or managed?

Like any disease, CVI is most treatable in its earliest stages. Vascular medicine or vascular surgery specialists typically
recommend a combination of treatments for people with CVI. Some of the basic treatment strategies include:

Avoid long periods of standing or sitting: If you must take a long trip and will be sitting for a long time, ex and
extend your legs, feet, and ankles about 10 times every 30 minutes to keep the blood owing in the leg veins. If you
need to stand for long periods of time, take frequent breaks to sit down and elevate your feet.
Exercise regularly. Walking is especially bene cial.
 Lose weight if you are overweight.
Elevate your legs while sitting and lying down, with your legs elevated above the level of your heart.

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Wear compression stockings.
Take antibiotics as needed to treat skin infections.
Practice good skin hygiene.

The goals of treatment are to reduce the pooling of blood and prevent leg ulcers.

Compression Stockings

The most conservative approach is to wear properly- tting support hose (also called compression stockings).
Compression stockings can be purchased at some pharmacies and medical supply stores and come in various styles,
including below-the-knee, above-the-knee and pantyhose styles. They also come in different compressions varying from 8
to 10 mm Hg, up to 40 to 50 mm Hg. Your doctor can recommend the compression that is right for you. You will need a
prescription for any stockings with more than 20 mm Hg compression.

If you wear compression stockings, be sure to take them off at the end of the day to wash and dry them, and to clean and
check your skin. Make sure the stockings t so there is no bunching. Elastic stockings that t poorly can actually make
your condition worse by blocking blood ow in the area where they have bunched up.

Some studies have shown that combining elastic socks with prescription medication to improve blood ow is very
effective when the socks alone do not control symptoms.

Antibiotics

Antibiotics may be prescribed to clear skin infections related to CVI, but the underlying disease must be treated to
prevent a recurrence. Deeper infections and ulcers may also be treated with antibiotics.

Other Medications

If you have post-thrombotic syndrome, your doctor may prescribe medication to prevent the formation of additional
blood clots.

A special medicated wrap, known as an Unna Boot, combines multilayer compression with a zinc oxide gel-based wound
cover that forms a semi-rigid bandage. Other multilayer compression systems are available and are often used in
combination with topical wound care products.

Some patients have found bene t from the herbal dietary supplement Vena-Stat, which contains a derivative of horse
chestnut extract. Keep in mind that herbal preparations should not be used in place of your prescription medications and
should be used with caution, as they may interact with current prescription medications. Please ask your doctor or
pharmacist about any potential drug interactions.

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Skin Care

Practicing good skin hygiene is important. Keep your skin moisturized so that it doesnt ake or crack easily. If the skin is
not broken or leaking uid but is in amed, your doctor may recommend an anti-itch cream, such as one containing
hydrocortisone; a cream containing zinc oxide to protect the skin; or an antifungal cream to prevent fungal infections.

Skin that is leaking uid is treated with wet compresses. If you have ulcers on your legs, your doctor will show you how to
apply layered compression bandages to protect the skin and maintain blood ow.

Nonsurgical Treatment

Nonsurgical treatments include sclerotherapy and endovenous thermal ablation.

Sclerotherapy involves the injection of a solution directly into spider veins or small varicose veins that causes them to
collapse and disappear. Several sclerotherapy treatments are usually required to achieve the desired results.
Sclerotherapy is simple, relatively inexpensive, and can be performed in the doctors of ce. Sclerotherapy can eliminate
the pain and discomfort of these veins and helps prevent complications such as venous hemorrhage and ulceration. It is
also frequently performed for cosmetic reasons.

Endovenous thermal ablation is a newer technique that uses a laser or high-frequency radio waves to create intense local
heat in the affected vein. The technology is different with each energy source, but both forms of local heat close up the
targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and
bruising. Compared with ligation and stripping, endovenous thermal ablation results in less pain and a faster return to
normal activities, with similar cosmetic results.

Surgical Treatments

When is surgical treatment necessary?

For the less than 10 percent of patients who require surgical treatment, the options include vein ligation and stripping,
microincision/ambulatory phlebectomy, and bypass surgery. Here is a brief review of each of these techniques. Your
doctor can recommend the treatment that is most appropriate for you.
Ligation and stripping often are performed in combination. Vein ligation is a procedure in which a vascular surgeon cuts
and ties off the problem veins. Most patients recover in a few days and can resume their normal activities. Stripping is the

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surgical removal of larger veins through two small incisions. Stripping is a more extensive procedure and may require up
to 10 days for recovery. It usually causes bruising for several weeks after surgery.

Microincision/ambulatory phlebectomy is a minimally invasive procedure in which small incisions or needle punctures
are made over the veins, and a phlebectomy hook is used to remove the problem veins.

Vein bypass in the leg is similar to heart bypass surgery, just in a different location. It involves using a portion of healthy
vein transplanted from elsewhere in your body to reroute blood around the vein affected by CVI. Bypass is used for
treatment of CVI in the upper thigh and only in the most severe cases, when no other treatment is effective.

Can chronic venous insu ciency be prevented?

To reduce your risk of developing CVI, follow these guidelines:

Eat a healthy balanced diet.

Quit smoking.
Exercise regularly.
Avoid wearing restrictive clothing such as tight girdles or belts.
Lose weight if you are overweight.
Avoid prolonged sitting or standing.

Reviewed: 12/15

Chronic Venous Insu ciency (CVI): Doctors Who Treat

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available.
The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how
well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes (https://
my.clevelandclinic.org/services/heart/about-heart-vascular-institute/outcomes-and-stats).

Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The
following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease,
including blood clotting disorders:

Section of Vascular Medicine (~services/heart/departments-centers/specialty-centers-and-clinics/vascular): for

evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive
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computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call
Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.
Department of Vascular Surgery (~/services/heart/departments-centers/departments/vascular-surgery-department):
surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call

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You may also use our MyConsult (http://my.clevelandclinic.org/online-services/myconsult) second opinion consultation
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See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute. (~/services/heart/a
bout-heart-vascular-institute)

Reviewed: 12/15

Chronic Venous Insu ciency (CVI): Resources & Patient Info

Contact

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Reviewed: 12/15