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:
- 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:
- Heaviness sensation
- Legs feel tight and restless
- 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.
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.
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