Chronic venous insufficiency (CVI) is a worldwide occurring disease. In fact, it’s prevailing in the industrialized countries due to low vitamin F intake or low fiber intake leading to constipation or abdominal pressure. In short, CVI is a disturbance in the venous flow at the level of the limbs because of incompetent valves, blockage of large-caliber leg vein or both.

Risk factors of CVI based on CEAP classification:

• Age
• Sex
• Nature of work such as long-standing time
• Genetic factors (family history of varicose veins)
• Geographic factors
• Obesity and lack of exercising especially in women
• Number of pregnancies (more than 2)
• Injury in leg (DVT)

Classification of chronic venous insufficiency:

Indeed, the classification of CVI is done according to CEAP classification. In other words, it is done according to clinical, etiological, anatomical and pathophysiological criteria and it includes 7 groups taking into consideration how lower limbs skin looks like, edema presence, teleangiectasis and varicose ulcers.
-Group C1 - telangiectasis, reticular veins, and redness of the skin around the ankles.
-Group C2 - varicose veins
-C3 Group – presence of edema, absence of skin changes
-Group C4 – lesions related to venous diseases (discoloration, blemishes, lipodermatosclerosis);
-C5 Group - skin changes with signs of healed venous ulcers
-Group C6 - skin lesions such as in groups C1 to C4 and active venous ulcers.
-ETIOLOGICAL CLASSIFICATION INCLUDES: Ec - congenital defects, Ep - primary pathological changes, without identification of their causes; Es - secondary causes of venous insufficiency of known etiology (post-thrombotic, post-traumatic, etc.)

Leg symptoms due to chronic venous insufficiency:

• Itching
• Heaviness sensation
• Legs feel tight and restless
• Swelling
• Standing or sitting after pain
• Walking pain
• Muscle cramps

Diagnosis of CVI:

Ultrasound Doppler is mostly effective since it’s non-invasive, constantly available, and the ultrasound machines are often enhanced. On the other hand, invasive methods including several types of phlebography are used for very high diagnosis uncertainty.

Treatment:

A combination of invasive procedures, compression and pharmaceutical treatments is the key treatment to venous diseases. Thus, using medical compression stockings along with anti-inflammatory drugs is the most common approach in non-invasive methods. As a matter of fact, for saphenous vein varicosis, stripping operations and endovenous thermal ablations (less invasive). Besides, Foam sclerotherapy and percutaneous phlebectomy are used to eliminate side branch varicosis; however, varicose veins might recur often.

References:

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-Carpentier P, Priollet P. Epidémiologie de l'insuffisance veineuse chronique [Epidemiology of chronic venous insufficiency]. Presse Med. 1994 Feb 10;23(5):197-201. French. PMID: 8177867.

-Wrona M, Jöckel KH, Pannier F, Bock E, Hoffmann B, Rabe E. Association of Venous Disorders with Leg Symptoms: Results from the Bonn Vein Study 1. Eur J Vasc Endovasc Surg. 2015 Sep;50(3):360-7. doi: 10.1016/j.ejvs.2015.05.013. Epub 2015 Jun 30. PMID: 26141786.

-Goel RR, Hardy SC, Brown T. Surgery for deep venous insufficiency. Cochrane Database Syst Rev. 2021 Sep 30;9(9):CD001097. doi: 10.1002/14651858.CD001097.pub4. PMID: 34591328; PMCID: PMC8483065.

-Rabe E, Pannier F. Was ist gesichert in der Therapie der chronischen Veneninsuffizienz? [What is evidence-based in the treatment of chronic venous insufficiency?]. Internist (Berl). 2020 Dec;61(12):1230-1237. German. doi: 10.1007/s00108-020-00899-6. PMID: 33141265.

-Kasperczak J, Ropacka-Lesiak M, Breborowicz HG. Definicja, podział oraz diagnostyka przewlekłej niewydolności zylnej - cześć II [Definition, classification and diagnosis of chronic venous insufficiency - part II]. Ginekol Pol. 2013 Jan;84(1):51-5. Polish. doi: 10.17772/gp/1540. PMID: 23488310.