Diagnosis and Management of Chronic Venous Insufficiency (CVI).pdf

Chronic Venous Insufficiency (CVI) is a progressive condition in which leg veins’ valves weaken or get damaged, causing blood to pool instead of flowing back toward the heart. Diagnosis is commonly by vascular ultrasound, and treatment options include minimally invasive procedures like endovenous laser therapy, radiofrequency ablation, and ultrasound-guided sclerotherapy.

1. Diagnosis and Management of Chronic Venous
Insufficiency (CVI)
Chronic Venous Insufficiency (CVI) — often simply called venous
insufficiency — is a common but under-appreciated vascular disorder. In
CVI, the veins in the legs are unable to return blood efficiently to the heart.
This leads to high pressure in the veins (venous hypertension), swelling,
discomfort, and over time, even skin changes and ulcers.
Why It Matters
Chronic Venous Insufficiency affects a significant share of adults,
especially with advancing age. The condition reduces quality of life
because of chronic leg pain, heaviness, itching, and swelling. Left
unchecked, it can worsen into serious complications like venous ulcers,
infections, and deep vein thrombosis.
Moreover, many people mistake the symptoms—leg fatigue, mild
swelling—as “just aging” or “standing too long.” That delay in seeking
help allows the disease to progress.
What Causes CVI?
The root problems are usually:
 Valve dysfunction / reflux in veins, causing backward flow of
blood.
 Obstruction in the venous circulation (less common), which
impedes forward flow.

2.  Muscle pump failure—the calf muscles play a role in pushing
blood upward; weakness or lack of movement impairs this.
Risk factors include older age, obesity, prolonged standing or sitting,
pregnancy, prior deep vein thrombosis (DVT), smoking, and genetics.

Signs & Symptoms to Watch For
People with CVI often describe:
 Leg heaviness, fatigue, aching or throbbing sensations
 Swelling, especially toward the end of day
 Itching, tingling or a feeling of tightness
 Visible varicose veins, reticular veins, or spider veins
 Skin discoloration, thickening, or scaling
 In advanced cases: venous ulcers, especially near the ankles

3. If symptoms worsen over time—e.g. swelling becomes persistent, or
ulcers form—that is a red flag for seeking specialized care.
How It’s Diagnosed
Diagnosis typically begins with a clinical evaluation of symptoms and
physical signs, and is confirmed with venous duplex ultrasound —
considered the gold standard to assess for reflux or obstruction.
Other diagnostic tools may include contrast venography or intravascular
ultrasound in more complex cases.
Treatment & Management Strategies
The goals of treatment are to relieve symptoms, prevent progression,
promote healing in advanced cases, and improve circulation.
Conservative approaches (first line) include:
 Compression therapy (elastic stockings, bandages) to reduce
venous pressure
 Leg elevation and avoiding long periods of standing/sitting
 Exercise / calf muscle strengthening
 Weight management, lifestyle changes, quitting smoking
If conservative care is insufficient, interventional procedures may be
used:
 Endovenous laser ablation or radiofrequency ablation
 Sclerotherapy
 Surgical ligation or vein stripping
 In select cases, stenting of obstructed veins