WHAT IS CHRONIC VENOUS INSUFFICIENCY

CVI (Chronic Venous Insufficiency) is a disease that affects a large percentage of the population worldwide. According to studies, up to 50-60% of people suffer from Chronic Venous Insufficiency of the Limbs and at the age of 50 it increases to 70%. Studies shows that women suffer more often than men.

CVI is a condition in which the vein wall and valves are affected and do not work effectively, resulting in difficulty returning blood from the lower extremities to the heart (venous stasis). As a result, the venous pressure in the lower limbs increases, the veins expand, leg swelling and other subjective complaints appear.

Symptoms of CVI may include:

• Swelling of feet and ankles
• Burning, tingling, tingling or "pins and needles" sensation in the legs
• Pain that  decreases with leg elevation
• Varicose veins
• Feeling of heaviness in the legs (lead legs)
• Painful muscle cramps
• Scaling or itching of the skin on the legs or feet
• Change in skin color
• Appearance of varicose ulcers

Without treatment, CVI slows the flow of blood from the legs to the heart and increases venous pressure. This leads to a number of changes, such as edema, deposition of blood cells and other products with a gradual change in skin color (from reddish to brown), impaired nutrition, gradual thinning and damage with the appearance of varicose ulcers. Usually, they are difficult to treat and are accompanied by complications.

The main risk factors:

• Deep Venous Thrombosis (DVT)
• Varicose veins or family history of varicose vein
• Gender – women suffer from CVI more often than men
• Age – over 50 years of age
• Pregnancy, oral contraceptives, hormone replacement therapy
• Overweight, obesity
• Smoking
• Immobility, lack of physical activity
• Prolonged standing or sitting

The CEAP international classification is used to determine the stage of CVI. It is based on four elements, hence the abbreviation CEAP:

1. Clinical manifestations (C)

2. Etiological factors (E)

3. Anatomical involvement of the disease (A)

4. Pathophysiological finding (P)

The classification is enriched with subgroups that allow precise determination of the degree, origin and localization of the disease.

Class C:

C0 - without visible signs of venous disease

There are no subjective complaints

C1 – telangiectasias (dilated intradermal venules less than 1 mm), reticular veins (dilated subdermal veins up to 4 mm wide, which cannot be palpated)

There are no subjective complaints

C2 – varicose veins (subcutaneous varicose veins, with a size equal to or greater than 3 mm in diameter)

Subjective complaints that do not impair the patient's ability to work (pain, heaviness, slight swelling around the ankles after prolonged standing) and usually occur at the end of the day and are often seasonal. They subside quickly after rest.

C3 – edema, without skin changes

Subjective complaints are significant, but usually do not impair the patients' ability to work

C4a – pigmentation, venous eczema

C4b – lipodermatosclerosis

C5 – skin changes and a scar from a healed venous ulcer

C6 – skin changes and active venous ulcer

In the last classes, the subjective complaints are significantly expressed and impair the working capacity of the patients to varying degrees.

Class E:

Ec- congenital

Ep- primary (idiopathic)

Es- secondary (post-thrombotic)

Class A:

As- superficial veins

Ad- deep veins

Ap – perforating veins

Class P:

Pr - reflux

Po - obstruction

Pr,o – reflux and obstruction

How is CVI diagnosed?

The diagnosis is made on the basis of anamnesis (it is important to specify the presence of risk factors for the development of CVI), examination - examination of the external manifestations of chronic venous disease, non-invasive examinations (Doppler, functional tests, etc.), and sometimes invasive research (phlebography).

CVI treatment

The treatment of CVI is always complex and includes a combination of non-invasive (lifestyle change, venotonic and other medications, compression therapy) and invasive means (various operative and minimally invasive techniques) in order to achieve the maximum effect in symptom control.

After consultation with a specialist, depending on the degree of the disease, you will be assigned an individual treatment!