Chronic Venous Insufficiency

Chronic Venous Insufficiency (CVI) is one of the leading causes of swollen feet, ankles and legs.

    • Someone with CVI may experience:
  • Ankle swelling
  • Tight feeling calves
  • Heavy, tired, restless or achy legs
  • Pain while walking or shortly after stopping

EnlargedVeinAndDamagedVeinThere are several things that can cause CVI. Ultimately, long-term blood pressure in the leg veins that is higher than normal can causes CVI. If the valves in the veins are damaged blood can pool in the lower extremities and cause varicose veins. Sitting or standing can stretch the superficial vein walls and damage the valves in the veins which keep blood from flowing back down the legs.

DVT happens when a blood clot (thrombus) blocks the blood flow back to the heart out of the deep veins or perforating veins, which connect the deep veins to the superficial veins. Deep vein thrombosis (dvt) can also cause CVI, because it blocks the flow of blood back to the heart and elevates the pressure inside the veins.

    • Factors that increase your risk of CVI include:
  • Family history of varicose veins
  • Being overweight
  • Not exercising enough
  • Being pregnant
  • Smoking
  • Sitting or standing for long periods of time

CVI can be diagnosed by your physician by taking your patient history and physical exam. The physician may also measure the blood pressure in your legs and examine any varicose veins you may have. To confirm a diagnosis of CVI, the physician will usually order a duplex ultrasound or a venogram. A duplex ultrasound uses sound waves to measure the speed of blood flow and visualizes the structure of the leg veins. A venogram is an x-ray that uses a dye (contrast) which enables the physician to see the veins.

ChronicVenousInsufficiencyChronic venous insufficiency is usually not considered a health risk; your physician will try to decrease your pain and disability. In mild cases of CVI, compression stockings or compression socks may alleviate the discomfort and swelling. Physicians usually use a 20-30mmHg compression stocking or a 20-30mmHg compression sock for this. The stockings will not make the varicosities go away, but is the least invasive treatment.

More serious cases may require sclerotherapy, ablation, or surgical intervention such as stripping to correct the problematic vein. This is usually done by a vascular specialist or vascular surgeon. During sclerotherapy a chemical is injected in the affected vein or veins and a scar will form from the inside of the vein. During ablation a thin, flexible tube (catheter) with an electrode at the tip will heat the vein walls at the appropriate location to seal the vein. When a vein stripping is done one of the saphenous veins is removed. The physician will make a small incision in the groin area and usually another in the calf below the knee. The veins associated with the saphenous vein will be disconnected and tied off and the vein removed. There are other surgical procedures which are done to improve your leg health. After one of the above procedures 20-30mmHg compression stockings are usually put on and you are told to wear them for a certain length of time. Some physicians will tell their patients on their follow-up visit that it is no longer necessary to wear the compression garments. For me, this is where I have some concerns. If the real underlining cause of CVI (such as family history of varicose veins, being overweight, not exercising enough, smoking or sitting or standing for long periods of time) has not been corrected why would you not continue to wear compression stockings to keep from developing CVI again.

Compression stockings and socks have come a long way in the last few years. They no longer look like the garments our grandparents wore. They look like ordinary stockings and socks. The stigma of wearing compression garments is past.

Here’s to feet, ankles, and legs that are no longer swollen,


Hope for Lymphedema Patients

A few weeks ago I heard about a lymphedema patient here in the US and I knew at that time that I had to share her story with you.

Jennifer had lymphedema of her right leg for over ten years. She had Complete Decompression Therapy (CDT), she wore compression garments during the day, and her night time compression garments at night. No matter how hard she tried and no matter how compliant she was her lymphedema progressed. She began searching for a surgeon who had the expertise to do lymph node transplants. Jennifer found her surgeon in New York.

Jennifer had the surgery 2 years ago in May. They removed 3 lymph nodes from the left thorax (not axilla) and transplanted them to the right groin. A year later she had a Lymph MRI which showed the lymph nodes which were transplanted and the very beginnings of lymph vessels. This was really exciting!

In March of this year she had her 2nd MRI. There were actually 5 lymph nodes in her right groin including the 3 transplanted nodes. Two lymphatic vessels were connected and growing. The vessel was about 1 mm in diameter and reaches half way down to the knee! Her physician considered this likened to a Highway! Her foot is no longer as swollen as it was and the ankle is beginning to show some shape. The tissue is beginning to soften, the fluid is movable and mushy, and the tissue no longer feels fibrotic.

Jennifer has progressed to bike rides, long walks and swimming. The physicians are considering a second lymph node transplant to the ankle area and some minor liposuction to remove fat deposits on the outside of the leg which was a result of the lymphedema. Jennifer also continues with MLD message therapy (Manual Lymphatic Drainage) to wake up the newly transplanted nodes and encourage the growth of new vessels. The MRIs she has had done are very valuable to the therapist because they visualize the lymph nodes and vessels and the therapist knows exactly where the fluid needs to be moved.

Her problems are definitely not ended, but there is now hope that someday she may lead a normal life.

To aide patients like Jennifer, Support Hose Plus is proud to offer a complete product line in compression stockings. As a family owned company, Support Hose Plus strives to offer you the best prices and the highest quality of customer service.

Looking forward to more news in the field of Lymphedema,