Initiаl Pоst оn Chrоnic Venous Insufficiency Introduction Chronic Venous Insufficiency (CVI) is а diseаse related to the venous system’s circulation, especially those within the lower extremities. While CVI is fairly common it is often overlooked by health care professionals. Its symptoms can vary from cosmetic concerns to severe symptoms. Because of this, CVI’s impact on the body can often be undervalued. There are three different kinds of veins: superficial, deep, and perforating veins. Within this system there are valves which assure blood flow in the correct direction. However, when there are abnormalities in these valves it causes chronic venous insufficiency (Youn and Lee, 2018). Etiology and Genetic Risk Chronic Venous Insufficiency is just what it sounds like. It is caused by insufficiencies in the venous system. Therefore, changes in the venous pressure will cause CVI. For example, ongoing elevation of venous pressures are due to a faulty valve (Mills and Armstrong, 2020). CVI can be characterized by “inadequate venous blood return, or venous pooling, over a long period that leads to venous distention and venous hypertension” (Berti-Hearn and Elliot, 2019). Because of the abnormality in vein function there is hypertension in these veins. This is because the valves are weakened creating a build up of blood, producing hypertension. Deep vein thrombosis, trauma to the valves, or any physiologic changes can result in CVI. In addition, those that are pregnant, obese, female, advanced in age, or who have a family history of varicose veins are at a higher risk of CVI (Youn and Lee, 2018). Clinical Assessments/Clinical Manifestations A common symptom of Chronic Venous Insufficiency is the patient feeling a heaviness in their legs. After prolonged standing, pressure is experienced that results in swelling, aching, or pain in the legs. Also varicose veins are often related to CVI. Varicose veins are large, dilated veins (Youn and Lee, 2018). Additionally, patients with CVI will experience “skin pigmentation changes due to hemosiderin deposits from the breakdown of red blood cells that have extravasated through damaged capillaries into the dermis “(Berti-Hearn and Elliot, 2019). Along with skin color changes, venous eczema can occur. Venous eczema is characterized by redness, crusting, and the leaking of fluid. Another symptom is the bilateral edema that takes place in the legs. This can be an indicator of congestive heart failure related to CVI (Youn and Lee, 2018). Furthermore, a give away for CVI is venous ulcers. These specific ulcers are shallow, and not to be confused with deep arterial ulcers. Venous ulcers are most commonly found on the ankles. They can be characterized by being a red color and having irregular edges (Berti-Hearn and Elliot, 2019). All in all, CVI has a variety of symptoms with different ranges of severity. Clinical Practice Standards While Chronic Venous Insufficiency can nearly be diagnosed off of symptoms alone, it is beneficial to conduct labs to confirm the diagnosis. The first test that can be given is an ankle-brachial index (ABI). This will check the patient’s pulse in their lower extremities. In addition, “Using ultrasonography, clinicians can determine the presence and direction of blood flow through the veins, detect any reflux or obstruction of blood flow, and establish the location of obstructions” (Berti-Hearn and Elliot, 2019). A common system is the CEAP. This stands for the clinical, etiological, anatomic, and pathophysiological system. It classifies edema, skin pigmentation, varicose veins, and ulcers. The etiology part of it is rating it between primary and secondary. The anatomy of this test consists of the effects between superficial, deep, or perforator veins. The last part of this assessment is the pathophysiologic side. It includes whether or not venous reflux (where blood flows backwards and not correctly towards the heart), clots, or obstructions are occuring. Based on these symptoms, there is a venous severity scale. These levels range from absent (0) to severe (3). Some categories shown in this chart are pain, ulcers, edema, skin pigmentation, and a list of other symptoms. It is important to note that during the physical assessments the patient should be standing upright to allow for the maximum pressure within the veins (Youn and Lee, 2018). Moreover, there are various treatment options for Chronic Venous Insufficiency. “Conservative treatment requires graded compression” (Mills and Armstrong, 2020). An example of compression can be a patient wearing compression stockings. These specific stockings are used to disperse pressure across the leg. This level of compression limits ulcers and varicose veins. Along with compression stockings, certain medications can be used to treat CVI. Venoactive drugs are used as treatment in addition to Pentoxifylline to focus on inflammation (Youn and Lee, 2018). Another option for the severe cases is surgery. These surgeries can be open or endovenous, meaning done within the vein (Mills and Armstrong, 2020). Lastly, patient teaching is of utmost importance. There are many details that can be overlooked if not explained. Ideas like patient’s not crossing their legs when sitting or standing for a long amount of time, to encourage the stop of smoking or for the patient to lose weight, and the significance of elevating their legs multiple times a day can make a huge impact on CVI (Berti-Hearn and Elliot, 2019). Conclusion To conclude, Chronic Venous Insufficiency is a disease that should not be underappreciated due to the various levels of the disease. CVI is an abnormality in blood flow within the body’s veins. It is important for healthcare professionals to assess a patient's lower extremities if they are showing symptoms. This is due to how impactful CVI can be to a patient’s everyday life and the activities they participate in. References Berti-Hearn, L., & Elliott, B. (2019). Chronic venous insufficiency. Nursing, 49(12), 24–30. https://doi.org/10.1097/01.nurse.0000604688.03299.aaLinks to an external site. Mills, J., Sr., & G Armstrong, D. (2020, February 18). Chronic venous insufficiency - Symptoms, diagnosis and treatment | BMJ Best Practice. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/507Links to an external site. Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019 Mar;34(2):269-283. doi: 10.3904/kjim.2018.230. Epub 2018 Oct 26. PMID: 30360023; PMCID: PMC6406103.