Varicose Veins + Chronic Venous Insufficiency (CVI)
May 06, 2015
By James B. Williams, MD
Varicose veins are enlarged veins that can be blue, red, or flesh colored.
They are often raised above the skin on legs and look like twisted bulging cords. Varicose veins occur when the valves in the veins that carry blood from the legs toward the heart no longer function, causing blood to pool. Often misunderstood as a cosmetic issue, varicose veins can progress to CVI, which is a more serious condition.
CVI is a progressive medical condition in which the valves that carry blood from the legs to the heart no longer function, causing blood to pool in the legs and veins to swell.
Healthy leg veins are designed to allow blood to flow against gravity from the legs back toward the heart. Tiny valves inside the veins open and close to help control the flow and pressure. CVI occurs when stresses on the venous system like pregnancy, age, or standing for long periods of time weaken and stretch the vein structure. When the veins become weakened or diseased, the blood flow is obstructed and blood pools in the legs. This impaired blood flow (or reflux) causes veins to expand, lose form and protrude from beneath the skin.
Without treatment, people with CVI may experience progressive symptoms
that can be debilitating and significantly impact quality of life. People who suffer from CVI may experience:
CVI can affect anyone.
- Leg heaviness and fatigue
- Leg or ankle swelling
- Leg pain, aching, or cramping
- Varicose veins
- Skin changes or rashes
- Ulcers, open wounds, or sores
Gender and age are large factors that may increase your risk for developing the disease. For example, women older than 50 are more likely than others to develop venous disease that can lead to CVI. The disease is often hereditary and can affect several members of the same family.
The following factors may increase your risk:
For mild forms of venous disease, lifestyle changes may be recommended to control existing symptoms and prevent others.
- Sedentary lifestyle
- Lifestyle or occupation that requires prolonged standing
- Obesity or excess weight
- Current or previous pregnancies
The following measures may help prevent varicose veins and CVI:
Spider veins, which often cover the legs and even the face, are damaged veins that appear to be similar to varicose veins,
- Manage blood pressure and body weight
- Exercise regularly, focusing on exercise that work your legs (i.e. run or walk)
- Elevate your legs whenever possible
- Avoid prolonged standing or sitting
- Avoid clothes that are tight around the waist, thighs or legs
- Strengthen calf muscles and avoid shoes that limit use of calf muscles (i.e. high heels)
- Eat a diet low in salt and rich in high fiber foods
only thinner. They may be red or blue and look like thin spider webs or branches. These veins are closer to the surface of the skin and can spread over a range of areas. Unlike varicose veins, spider veins are typically not raised above the skin’s surface. Spider veins can be treated with sclerotherapy or laser treatment. Though spider veins may be associated with varicose veins or CVI, the issue is seen as cosmetic and treatment is elective.
Screening for CVI is done through a simple, non-invasive ultrasound
test conducted by a Registered Vascular Technologist (RVT) or sonographer. The ultrasound uses sound waves to measure the speed and blood flow through the vessels in the leg. The ultrasound test also produces an image of the vein structure, offering a vein specialist a visual of the veins, valve damage, and any vein obstructions that may be causing CVI. If the ultrasound confirms that you have CVI, the vein specialist will discuss treatment options and help you identify the best fit for your lifestyle.
Today, there are a number of available treatment options for CVI that are covered by many insurance plans. While conservative treatments like compression stockings are often first prescribed to manage symptoms, there are a variety of other therapies that can treat the underlying disease to eliminate varicose veins and halt the progression of CVI.
Endovenous thermal ablation
is a minimally invasive treatment that involves the insertion of a thin, flexible tube called a catheter into a diseased vein to seal it shut using heat. Blood that would normally return to the heart through these veins will then travel through other veins instead. The treated vein dries up, shrinks and is absorbed by the body. Two types of energy may be used:
- Radiofrequency Ablation uses radiofrequency energy to provide an even and uniform heat to contract the collagen in the vein walls, causing them to collapse and seal off. As of October 15th, 2013, Venefit™ targeted endovenous therapy using the Covidien ClosureFast™ catheter is the only form of radiofrequency ablation for the treatment of CVI in the United States.
- Laser Ablation delivers laser energy to heat the blood, causing it to coagulate (solidify) and close off the diseased vein. Popular laser ablation treatments include the ELVeSTM* PL laser system, VenaCure EVLTTM* System and Medilas D FlexiPulse system.
is a varicose and spider vein treatment in which a chemical solution is injected into problematic veins. This solution irritates the vein lining causing it to undergo fibrosis and eventually disappear; abnormal veins can then no longer fill with blood. In a few weeks, the diseased vein will be absorbed by the body and blood flow will be rerouted to other veins. Multiple treatments may be needed to close the damaged vein. Vein specialists will often use sodium tetradecyl sulfate (SotradecolTM*) or polidocanol (AscleraTM*) treatments, which can be done in a doctor’s office without anesthesia.
Vein Ligation and Stripping
is performed under anesthesia by a surgeon in an outpatient setting. First, the surgeon will perform the ligation, where the diseased vein is tied off. Then, the surgeon will surgically remove, or strip, the diseased vein through two small incisions in the groin and calf. Recovery is more extensive than with endovenous ablation treatment options.
Are you suffering from varicose veins or CVI? There is help available. Contact the Cardiac Thoracic & Endovascular Therapies, S.C., at 309-680-5000. Dr. Williams is board-certified in three surgical specialties: cardiothoracic, vascular, and general. ‘Easy in, Easy Out’ service advantages. Visit www.cvendo.com. Located at 2420 W. Nebraska Avenue, Peoria, IL.
Images courtesy Cardiac Thoracic & Endovascular Therapies
Back to Top