Although many people haven’t heard of it, chronic venous insufficiency (CVI) is an all-to-common condition. While there’s debate about its exact prevalence, there is agreement that CVI is one of the most widespread conditions in the United States.
There are tiny valves in the deeper leg veins that return blood back to the heart. In CVI, these valves stop working and blood pools in the veins. All symptoms manifest in the legs, and include swelling, achiness, discoloration, varicose veins, rashes and ulcerations. Not all patients have all symptoms.
Dr. W. Clark Beckett is a board-certified vascular surgeon in Vero Beach who specializes in varicose veins and venous disease. He agrees that the condition is “quite common,” and that it’s not unusual for him to see 10 or 15 patients a week with CVI; he estimates that number as being 20-25 percent of his patient population.
Dr. Beckett says the most significant risk factor is a prior history of deep vein thrombosis. Thrombus means blood clot, and DVT is a clot in one or more of the deep veins in the body, most commonly in the legs.
“In DVT, the venous pressure gets very high, and it’s almost a given that the valves, which are supposed to return blood to the heart, are badly damaged and stop functioning properly,” he explains.
Age is another risk factor. “The older we get, the longer we have been on our feet,” says Dr. Beckett. “And people whose occupation required them to stand for much of their work life are at even greater risk.” Occupations in that category include nurses, hair cutters, retail salespeople, mail carriers artists and many others. Women are more at risk than men, due to the effects estrogen has on the valves; pregnancy can also result in damaged valves.
Dr. Beckett says the “gold standard” for diagnosing CVI is a procedure called duplex ultrasound. “The first ultrasound shows if the veins are open, or if they are occluded.” Next is a Doppler ultrasound, which uses reflected sound waves to allow the physician to listen to the flow of blood across valves. “We know there is a problem if blood is flowing backwards toward the feet rather than forward towards the heart,” Dr. Beckett says.
The mainstay treatment has been the same for many decades – compression stockings. If there are sores present, wound care and infection control are needed first. This is typically accomplished by:
• Cleansing the sores with antifungal medication to seal out moisture
• Applying an antibiotic ointment
• “Dressing” the sores with a sterile pad that contains silver-coated nylon fibers
• Applying a secondary dressing, often made from polyurethane foam
For compression, a multi-layer wrap is used. Once the sores have healed, the patient can begin using compression stockings.
Jim Reukauf is a Vero Beach resident currently in the midst of his second bout with CVI. When it first occurred in 2012, he noticed changes in his lower legs; they turned dark and sores developed. With the standard treatment, the condition cleared up in just a couple of months, but returned in 2014.
Jim is currently in the “wound care” phase of his treatment. He has discoloration and sores, but feels fortunate that he has no pain or discomfort. Jim wears the leg wraps 24 hours day, and a nurse visits twice a week to clean his sores and change his dressings. “I’m careful to elevate my legs above my heart whenever I sit,” Jim says. “I also don’t stand for long periods of time. And I know that a lot of perspiration under the wraps would delay the healing, so I try to stay cool.” Jim’s treatment has gone on for a long time – about 6 months. He hopes to be out of the wraps and into compression stockings in another week or two.
Another risk factor for CVI – which does not apply to Jim – is being overweight. Along with the mainstay treatment, Dr. Beckett advises his overweight patients to lose weight and to exercise. “Losing weight will reduce swelling and improve symptoms of CVI,” he says.
Although Dr. Beckett is a vascular surgeon, he rarely recommends surgery as a treatment option.
There are exceptions: Dr. Beckett spoke of one unusual situation in which a surgical procedure may be indicated. “In the superficial vein system, there is a long vein called the saphenous. If the valve problem is in that vein, it’s not a deep vein problem and an ablation could possibly be performed.”
But in the vast majority of cases, the best treatment is compression, elevation, exercise and avoidance of prolonged standing.
Dr. Beckett is often asked to consult on complex cases by the patient’s primary care physician. “It never hurts to have a vascular surgeon review the case to help achieve the best long-term management so the patient can be as comfortable and productive as possible.”
Dr. Beckett is the owner of Vein Therapies. His office is located at 3770 7th Terrace in Vero Beach; the office phone number is 772 567 6602.
