Chronic venous insufficiency or CVI is a medical condition where the veins cannot pump enough oxygen-poor blood back to the heart. It is sometimes referred to as an "impaired musculovenous pump", this is due to damaged or "incompetent" valves as may occur after deep vein thrombosis (when the disease is called post-thrombotic syndrome) or phlebitis. Paratroopers, utility pole linemen, and men with leg injuries can suffer from damaged leg vein valves and develop this condition. Ordinarily, women make up the largest demographic for this problem.

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Symptoms
Diagnosis
Treatment Options

SYMPTOMS

As functional venous valves are required to provide for efficient blood return from the lower extremities, CVI often occurs in the veins of the legs. Itching (pruritis) is sometimes a symptom, along with hyperpigmentation of the legs. Symptoms of CVI include phlebetic lymphedema and chronic swelling of the legs and ankles. The skin may react with varicose eczema, local inflammation, discoloration, thickening, and an increased risk of ulcers and cellulitis. The condition has been known since ancient times and Hippocrates used bandaging to treat it. It is better described as chronic peripheral venous insufficiency.

DIAGNOSIS

CVI has been reported in the central nervous system of several persons. When it appears into the CNS is called Chronic cerebrospinal venous insufficiency (CCSVI). It can be seen using transcranial doppler sonography or MRV (magnetic resonance venography).

TREATMENT OPTIONS

Venous valve incompetence is treated conservatively with manual compression lymphatic massage therapy, skin lubrication, sequential compression pump, ankle pump, compression stockings, blood pressure medicine, frequent periods of rest elevating the legs above the heart level and using a 7-inch bed wedge during sleep. Surgical treatments include the old Linton procedures and the newer subfascial endoscopic perforator vein surgery. Some experimental valve repair or valve transposition procedures as well as some hemodynamic surgeries are being pursued. This whole field of medicine while ancient is still filled with complications e.g. Sometimes an artery can strangulate a vein or sometimes an arteriovenous fistula (an abnormal connection or passageway between an artery and a vein) may be causing the apparent poor venous return.

Patients are often encouraged to walk while wearing the prescribed medical stockings and to sleep in a 6 degree Trendelenburg position. Obese or pregnant patients might be advised by their physicians to forgo the tilted bed.

Surprisingly, leech therapy and maggot debridement, long ago abandoned by medicine, can actually be beneficial treatment. The leeches draw out the excess venous blood that has carbon dioxide and metabolic wastes in a measured amount with little danger of dropping the blood volume. The maggots only eat dead flesh. Maggot debridement, actually is more thorough than surgical scraping. The FDA has approved maggot debridement. The maggots are raised in a sterile environment and encased in a mesh so they can eat the dead flesh and not crawl around.