Know the Facts
Chronic venous insufficiency (CVI) or obstruction occurs when there is damage to the valves in the veins of your leg. When this happens, the blood has a difficult time returning blood to the body. This causes blood to pool in your legs, increasing the pressure in your leg veins. The abnormal flow that occurs because of an underlying blockage may result in symptoms of chronic venous disease.
This can happen to any of the veins in your leg such as the deep veins, superficial veins or the perforating veins.
Post-thrombotic syndrome can be a result of a deep vein thrombosis (DVT). Blood clots are usually treated with blood thinners. However, after the clot has resolved, it can leave scar tissue in the vein. This scar tissue can either damage the valves leading to a backward flow of blood or a blockage in the vein resulting in poor blood return to the heart.
Chronic venous insufficiency or obstruction usually affects people over the age of 50, and affects about 1 in 20 adults.
Recanalization or opening of the vein without a procedure occurs in about one fourth of patients.
Symptoms
Symptoms may include heavy achy legs, skin discoloration or ulceration. There may be swelling in the lower legs, especially at the end of the day.
Causes
When the valves are damaged, blood flows backwards, a situation known as venous reflux. Damage can be congenital- meaning you were born with it. Sometimes there are changes to your leg that prevent the valves from functioning correctly. Other times it can be due to another medical condition, like a DVT, which is the most common cause.
Risk Factors
- Family history of chronic venous insufficiency or obstruction
- Being female
- Being tall
- Obesity
- History of DVT
- Standing or sitting for long periods of time
Evaluation
Workup of patients suspected of having chronic venous insufficiency or obstruction includes an ultrasound (imaging of the veins using sound waves) of the leg and pelvis. Additional evaluation may be required in some patients with either CT (computer tomography) scan or MRI (magnetic resonance imaging). MRIs use strong magnets to make images; they do not expose you to radiation. CTs use a series of x-rays to form a picture.
Evaluation after the above non-invasive tests or identification of blockage may require use of venography (minimally invasive procedure where a catheter (tube) enters the venous system from the groin or neck, and x-rays are used to visualize the vein) and intravascular ultrasound (a sound wave device placed into the vein to take pictures from the inside) to determine the extent and degree of blockage.
Treatment Options
A venous angioplasty is performed using x-ray and contrast dye. A needle is placed into one of the veins in the lower leg after a numbing medication has been given. A wire and catheter (small tube) is then passed up the vein to the place where the blockage is located. Pictures are taken with x-rays and dye to visualize the areas of blockage. With some maneuvering, a wire is passed through the blockage. A balloon can then be passed over the wire and blown up to increase the size of the vein; the balloon is then removed. This alone does not keep the vein open and oftentimes a stent (thin metal-mesh tube) is then placed from the inside.
Prevention
- Keep a healthy weight
- Eat a heart-healthy diet
- Exercise regularly
- Do not stand or sit for too long
- Avoid wearing restrictive clothing
What is different about Stony Brook Vein Center's approach?
At Stony Brook Vein Center, some of the treatments mentioned above can be performed right in our office. Our highly knowledgeable, board-certified vascular practitioners offer comprehensive care tailored to meet your needs. We are also active in venous research, education and we lead the field in making clinical advances available to our patients.
To be evaluated for chronic venous insufficiency or obstruction please schedule an appointment with the Stony Brook Vein Center, call (631) 444-VEIN (8346) or visit https://vein.stonybrookmedicine.edu/.
To schedule a free vein screening, please complete our screening form.