Information On Chronic Venous Insufficiency (CVI )

Chronic venous insufficiency is an advanced stage of venous disease caused either by superficial (severe varicose veins) or deep (after deep vein thrombosis) venous pathology and characterized by an increased venous pressure during walking. Most often this condition is seen in the veins of the lower extremities. Symptoms include leg swelling, leg pain, and muscle cramps. This condition can predispose to venous thrombosis.

When the veins aren't returning blood to the heart well enough, the cells lining the veins don't receive enough oxygen, so they release substances in the blood. These substances cause inflammation. As part of inflammation, swelling occurs. Swelling is one symptom of venous insufficiency, and it also makes it harder for the veins to work, increasing the problem of venous insufficiency. The same substances that produce swelling increase the fragility of the veins. This would contribute to varicose veins.

The usual treatment in the early stages of CVI is elastic stocking to apply external pressure to the system and dressings and salves to treat the ulcers. The only treatment for advanced stages of the disease was surgery to tie off the perforator veins to relieve the pressure in the superficial system.

Now, however, techniques have been developed which permit vascular surgeons to either repair damaged valves in the large veins of the upper leg, or to bypass them using a length of vein with healthy valves from somewhere else in the body. Only one or two key valves must be restored to normal function to return pressures in the system to normal.

To date, however, only a fairly small percentage of the vascular surgeons competent to perform the operation have become familiar with it. This is unfortunate, given the lifetime of misery CVI can cause those it afflicts, and the relief the surgery bestows, both from the condition's chronic pain and all but incurable leg ulcers.

Three substances have proved useful in treating chronic venous insufficiency: horse chestnut extract, oxerutins, and Daflon. Horse chestnut extract is sold over-the-counter in the U.S. as Venastat. The other two are available in Europe but not the U.S.

The active ingredient of horse chestnut extract is escin. Oxerutins is a mixture of substances chemically derived from rutin, a naturally-occurring substance. Daflon is a mixture of 90% diosmin and 10% hesperidin, two bioflavanoids. Diosmin and hesperidin are found in citrus fruits.

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