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VENOUS INSUFFICIENCY & OPEN WOUNDS

What is Chronic Venous Insufficiency?

Chronic venous insufficiency (CVI), also known as chronic venous disease (CVD), is a medical condition that describes the collection of symptoms that result from long-term vein problems. As vein disease progresses and more veins are affected, the leg may become swollen while the skin becomes firm and discolored due to the insufficient flow and accumulation of blood in the veins. If left untreated, vein disease can lead to open wounds, also known as venous leg ulcers.¹⁻³

What can Happen if Venous Insufficiency is Left Untreated?

If left untreated, CVI can continue to progress, leading to further leg swelling, adverse skin changes, and a host of other symptoms including pain (especially during physically activity), aching, itching, and cramping. The end-stage of chronic venous disease is venous leg ulcers that can be painful and difficult to heal.⁶⁻⁸

How is Venous Insufficiency Treated?

Chronic venous insufficiency is an advanced condition that often necessitates a multi-disciplinary medical approach to overcome. Both superficial and deep veins may be affected, and multiple types of treatments may be required to heal the leg. While we cannot provide all treatments that may be necessary to address your advanced CVI, we will work with trusted specialists to ensure that you're receiving the best possible care.

Compression therapy is the standard conservative approach to chronic venous insufficiency, and may be used alongside wound care techniques in the instance of a venous leg ulcer. Special 'graduated' compression stockings are typically used to ease the movement of blood through the veins.⁴

Surgical techniques are sometimes used in addition to compression therapy. The most common surgical techniques are ligation & stripping, bypass surgery, and valvuloplasty; however, minimally invasive vein treatments have mostly eliminated the need for surgical approaches.³

Superficial vein treatments may be used if ultrasound shows reflux (back-flow) in major superficial veins. Minimally invasive treatments can be used to shut down superficial veins that are suspected to be contributing to CVI. In comparison to varicose vein treatment, good quality evidence is limited regarding the benefit of superficial treatment to improve CVI and eliminate wounds, but positive outcomes have been reported by multiple authors.³

Deep vein treatments are used to address reflux in the deep veins that is suspected to contribute to CVI. Stents may be placed in the deep veins to improve blood flow against vein compression or obstruction. Like superficial treatments, there is an absence of good quality evidence showing benefit of deep vein treatment to improve CVI and eliminate wounds, but positive long-term outcomes have been reported.³

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References

[1] Eberhardt and Raffetto (2014). Contemporary Views in Cardiovascular Medicine: Chronic Venous Insufficiency. Circulation. 2014;130:333-346.

[2] Cesarone MR et al. (2002). ‘Real’ epidemiology of varicose veins and chronic venous diseases: the San Valentino Vascular Screening Project. Angiology 2002; 53: 119–130.

[3] Meissner, M. H. (2016). What is effective care for varicose veins? Phlebology, 31(1_suppl), 80–87.

[4] Howard M. Kimmel et al. An Evidence-Based Algorithm for Treating Venous Leg Ulcers Utilizing the Cochrane Database of Systematic Reviews. WOUNDS 2013;25(9):242-250

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