What is Chronic venous insufficiency?
Chronic venous insufficiency (CVI) also referred to as Varicose veins is a common condition that typically involves lower extremity edema, trophic skin changes, and discomfort secondary to venous hypertension.
Disability-related to chronic venous insufficiency can contribute to a significantly diminished quality of life and a loss of productivity.
In most cases, this condition is caused by the incompetence of the valvular action of venous walls.
If CVI is left untreated it is usually progressive and leads to the post-phlebitic syndrome and venous ulcers
Causes
Venous insufficiency syndromes are most commonly caused by valvular incompetence in the low-pressure superficial venous system.
It may also be caused by valvular incompetence in the high-pressure deep venous system (or, rarely, both).
It may result from the congenital absence of venous valves.
If the valves no longer function this can translate into elevated ambulatory venous pressure and can produce symptoms.
Presence of any abnormality in pump functions of calf muscle plays a significant role in the development of CVI.
So, what happens during Venous Insufficiency?
In venous insufficiency states, venous blood escapes from its normal antegrade path of flow and refluxes backward down the veins which results in retrograde flow and stasis, or pooling, of venous blood in the branches of the saphenous veins.
Symptoms
The associated symptoms, include:
Dilated visible veins at the skin surface (varicose veins, reticular veins, and telangiectasias),
Swelling
Chronic oedema
Pain,
Heaviness
Skin discoloration and cosmetic changes
Potential ulcer formation.
A poor calf pump mechanism may worsen venous reflux.
Sense of discomfort in legs is often referred to as weight or pain after standing for a long time and it is relieved by leg elevation.
Risks of cellulite,
Delayed wound healing.
Chronic venous insufficiency contributes to the development of lymphedema
Treatment
Surgical management includes
Ligation and stripping of the greater saphenous vein with avulsion of tributary veins
The alternative of the above is the catheter-based endovenous thermal ablation (EVTL). EVTL is performed with either laser or radiofrequency as the source of the heat energy. The EVTL procedure is typically performed under ultrasound guidance and with a local anesthetic.
Supplemental procedures are:
Liquid sclerotherapy which involves the injection of a dilute medication (sclerosant) into the superficial telangiectasias and reticular veins.
Phlebectomy which involves the removal of larger superficial varicose veins through small 2 mm to 3 mm incisions.
Laser therapy is only used to treat the spider veins and is not useful for varicose veins
Conservative management
Physical therapy.
Patient education is essential.
Patients with CVI should encourage to maintain a normal body weight, exercise daily (a walking program is especially good) and wear compression garment throughout the day as this is a chronic condition and needs a life-long care.
The control of weight, care of the limbs and optimum exercises to keep the calf muscles and ankle joint supple are among the strategies.
Compression stockings
Compression therapy is considered the “gold standard,” provided by means of elastic stockings, bandages and pneumatic compression devices.
For compression rates the recommended graduation is 20-30 mmHg and in more severe cases can be elevated to 30-40 mmHg.
Most patients obtain adequate symptom relief by using long-term graduated compression stockings, and through leg elevation.
Your Physical Therapist will be right guide to assess if there is any contraindications to be considered before deciding on any means of compression therapy.
Structured exercise program
In patients with CVI, progressive exercise program have been used to rehabilitate the muscle pump function and improve symptoms.
CVI causes ankle immobility due to storage of fibrotic tissue. Because of immobility, the calf muscle pump cannot be activated and venous blood does not return to the heart
A normal walking motion is required for activation of the calf muscular pump. It has been found that exercise program twice a week increased the angle of dorsiflexion and plantar flexion in those with CVI
Complete decongestive therapy (CDT)
It is a treatment program consisting of two phases.
First phase is the phase in which the edema is decreased and lasts for 4 or more weeks and consists of four components as follows: (1) manual lymph drainage (MLD), (2) skin care, (3) compression bandage and (4) therapeutical exercises.
The second phase is the one in which the decreased volume is protected with skin care, compression stocking and exercises.
Intermittent Pneumatic compression (IPC)
Researchers believe that VCT systems do improve total tissue blood flow and oxygenation.
Kinesio taping
Although there is no definite evidence for its proprioceptive effect, it is thought to act by means of cutaneous mechanoreceptors.
Skin-taping increases the circulation in the region by creating convulsions that cause the dermis to rise up.
Kinesio Tape, which is frequently used in edema, hematoma and wound healing, has been used as an alternative to compression therapy in patients with venous insufficiency in recent years. Even if it is frequently used, Kinesio Tape has not been proven to have a positive effect on venous insufficiency.
In some studies, it has been shown that there was an increase in lymphatic circulation and venous return of individuals who underwent fan technique without strain.
At Valley Healing Hands, Brownsville, Texas we provide the best physical therapy for Chronic Venous Insufficiency or Varicose veins. Our highly skilled Physical therapists are quick in assessing, in identifying the risk factors and in planning the treatment routine. Our patients are completely satisfied with the services we provide. You may learn about what they have to say about us here and get connected to us here. Our patients love us and you too will!!!
Sources
Conservative Management of Chronic Venous Insufficiency, Özlem Çinar Özdemir and Mahmut Surmeli, Clinical physical therapy, May 31st, 2017, https://www.intechopen.com/books/clinical-physical-therapy/conservative-management-of-chronic-venous-insufficiency
https://www.physio-pedia.com/Varicose_Veins#