What is Chronic Venous Insufficiency?

President Donald Trump recently disclosed that he has chronic venous insufficiency (CVI), a condition affecting the veins in the legs that impacts approximately 150,000 new patients each year, according to the National Institutes of Health.

Columbia vascular surgeon Danielle Bajakian, MD, explains CVI symptoms and treatments, and shares healthy habits that improve circulation. 

What is CVI?

Healthy veins circulate blood from your feet to your heart. These veins have valves that prevent the blood from going in the wrong direction.

If you have chronic venous insufficiency (CVI), the veins in your legs aren't working properly, typically because the valves in the veins are damaged or weak. This makes it hard for blood to travel back up toward your heart, so the blood pools in your legs.

Who gets it?

CVI is more common in people over age 50, women, overweight individuals, those who have had multiple pregnancies, or people who stand/sit for long hours. Family history can also play a role.

What are the symptoms of CVI?

People with CVI may experience heavy, achy legs due to the blood pooling there. Symptoms also include swelling that is worse at the end of the day; bulging, ropey veins called varicose veins; darkening skin in the lower legs; or itchy skin at the ankles. Someone with advanced CVI may have open ulcers near the ankles.

Is there a risk for blood clots or ulcers?

There is a very low risk of deep vein blood clots, but superficial varicose veins can develop painful clots called thrombophlebitis.

Are there other complications of CVI, like skin changes or infections?

If the swelling in the legs is not controlled, the skin can harden (a condition called lipodermatosclerosis) and turn darker in color (called hyperpigmentation).

How is CVI diagnosed?

It can be diagnosed by your primary care doctor, who can refer you to a vascular specialist. Definitive diagnosis is performed with a duplex ultrasound (a test to check how well blood moves through your veins and arteries). 

How is CVI treated?

Treatment may begin with lifestyle changes, such as regular exercise, especially walking. Your doctor may also recommend elevating your legs, wearing compression stockings, or losing weight.

CVI can be found in either the deep vein system or the superficial vein system. For superficial venous insufficiency, there are many minimally invasive procedures that can be performed to alleviate the symptoms.

Are medications or surgery sometimes needed?

Lifestyle changes can improve symptoms, but they do not fix the underlying problem. If these measures do not sufficiently alleviate symptoms, there are several low-risk procedures that can be performed, usually in the office, to seal the abnormal veins and remove any superficial veins.

What is endovenous ablation or vein stripping?

Endovenous ablation is one of the most common ways to treat superficial venous insufficiency. This is an office-based procedure that uses ultrasound guidance and a local numbing medicine. A catheter is inserted into the vein to seal it. There is minimal downtime, and patients can return to regular daily activities almost immediately.

Vein stripping is an office-based procedure that physically removes the veins. With newer technologies such as ablation, stripping is now typically reserved for varicose veins and can be done through microincisions.

Can CVI be prevented?

Many times, CVI is a hereditary condition and cannot be prevented. However, there are many healthy habits that promote vein health. 

What can people do at home to improve circulation?

There are several ways to promote healthy circulation, such as getting regular exercise (especially walking), maintaining a healthy weight, elevating your legs after a long day, wearing compression stockings, and avoiding sitting or standing for long periods of time without moving around. Taking a small break to walk around your home or office is helpful.

Will CVI go away, or is it a lifelong condition?

While this is a lifelong condition, it can be managed very well with conservative therapy, and the minimally invasive procedures I’ve mentioned can be a great help in improving symptoms.