Chronic Venous Insufficiency

What is Chronic Venous Insufficiency?

Chronic Venous Insufficiency (CVI) is the general term that is used to refer to the presence of inadequately functioning veins in the lower extremities. Normal functioning veins serve as conduits to transport oxygen-depleted blood back to the heart and lungs for re-oxygenation, along with other functions. When veins are not able to transport blood they are considered non-functional.

How does Chronic Venous Insufficiency present?

There are different manifestations of CVI and varying degrees of severity.

At one end of the spectrum, CVI may present simply as a cosmetic concern without any symptoms and without any adverse effect on structure or function of the tissues that the veins are supporting. This is often observed as dilated veins under the skin, which may include Spider Veins or Varicose Veins.

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At the other end of the CVI spectrum, malfunctioning veins can be associated with symptoms and may adversely affect the structure and function of tissue that the veins are supporting. That’s because Varicose Veins pool blood resulting in increased venous pressure in the leg, which interferes with normal circulation. Symptoms that may be associated with CVI include pain and cramping often in the presence of swelling of the leg, foot and ankle. With more severe involvement, there may be changes in the texture and color of the skin of the legs, ankles and feet, which can eventuate in leg ulcers.

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How is Chronic Venous Insufficiency diagnosed?

The first step in diagnosis is the observation of atypical appearing veins, i.e., dilated veins; alteration in skin color or texture of the legs, ankles or feet; or symptoms of pain, cramping or swelling. A history of thrombophlebitis or injury to the legs may also provide a clue as to the presence of CVI. The presence of CVI may be confirmed with a non-invasive test known as Duplex Ultrasound (DUS). This procedure uses sound waves to observe not only the appearance of veins but the blood flow within them to determine any abnormalities that may be present. It is performed by a trained and licensed Technologist.

How is Chronic Venous Insufficiency treated?

Treatment will depend upon the specific veins that are found to be insufficient or non-functioning. For visible Spider Veins or Varicose Veins, Sclerotherapy is usually the treatment of choice for their removal. For very large Varicose Veins, Phlebectomy is used for their removal. When the Saphenous Veins (Great Saphenous or Small Saphenous Veins) are discovered by DUS to be insufficient to a significant extent, Endovenous Ablation is the preferred method for their removal. Endovenous Ablation is a safer, less invasive alternative to a procedure that is known as Vein Stripping & Ligation, which is now rarely performed.

In addition to the above procedures, the use of gradient compression hosiery is always beneficial to those with CVI. Sometimes there are insufficient veins that are not accessible to treatment with any of the above procedures or involve the deep veins, which cannot be removed or repaired. In those circumstances, the regular use of gradient compression hosiery is vital to optimize venous function in the lower extremities.

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10.32.09: Delegation and Assignment of Performance of Cosmetic Medical Procedures and Use of Cosmetic Medical Devices. This is a Maryland safety regulation which governs who can legally perform medical cosmetic procedures.  Dr. Green administers all injectable treatments (including Botox™, Juvederm™, Voluma™ , Kyblella™ and other fillers & Sclerotherapy) and laser treatments.

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