What is chronic venous insufficiency, as manifested, has risks

What is chronic venous insufficiency, as manifested, has risks
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Chronic venous insufficiency is one of the diseases of civilization. This is a modern epidemic. It has a multifactorial basis and is negatively supported by today's lifestyle.


Chronic venous insufficiency, a disease of the veins of the lower extremities, is one of the most modern diseases of civilization. It is referred to as the epidemic of the new century, and its multifactorial basis supports today's lifestyle.

It negatively affects the quality of life. 
It affects about 15% of the population in our territory.

It has been going on for a long time, and its treatment is just as lengthy and difficult or impossible without thorough adherence. 

In addition to genetic predisposition and other internal factors, a variety of external factors also contribute to its emergence, from a sedentary lifestyle to a lack of exercise.

The symptoms bother a person unpleasantly, however, the risk is the development of serious complications, which do not end only with skin defects.

Chronic venous insufficiency
chronic venous insufficiency, 
abbreviated CVI. 
Chronic = long-term, 
venous = venous, 
insufficiency = insufficiency,
also CHZI.  

The disease is associated with impaired blood flow from the veins of the lower extremities. This disorder of venous hemodynamics affects not only the veins but also all surrounding tissues, such as the skin.

The person most often observes skin changes, which are accompanied by other unpleasant subjective difficulties.

Among the objective problems, the most well-known are varicose veins of the lower extremities.

From the subjective group, people complain of leg pain and even annoying leg cramps.

Veins and ...

Veins are the vessels that carry blood to the heart.

Blood must also return to the heart from the lower limbs.

Blood, like everything on Earth, is affected by gravity. And it makes it difficult for her to return from her feet. The veins are therefore adapted to facilitate the flow upwards to the heart.

It is generally known that veins carry deoxygenated blood back to the heart and then to the lungs. In the lungs, the blood is re-enriched - saturated with oxygen and then expelled back into the body's circulation from the left ventricle through the aorta.

Arteries are those vessels that contain oxygenated, or oxygen-rich, blood.

However, more precisely , it is divided according to the fact that: The 
arteries lead blood from the heart ♥ ⇒  to the body.
Veins ⇒ ♥ TO the heart .

The lungs, which is a large pulmonary artery, go from the right heart, more precisely from the right ventricle to the lungs. And it carries deoxygenated blood.

In contrast, the 4 pulmonary veins carry oxygen-enriched blood back to the left heart, from which blood is expelled through the aorta into the great bloodstream through the left ventricle.

In addition to this detail, the arteries and veins also differ in their composition.

The wall of the arteries is thicker and contains a much larger amount of muscle fibers.

The vein wall has only a small amount of muscle fibers. And in different parts of the body, the veins themselves differ in construction.

An example is the veins of the limbs.

These contain flaps. Like the heart, it has valves that direct blood flow.

The vein valves in the lower limbs help the proper flow of blood upwards, back to the heart ⇒ ♥ .

In addition, the flow of blood in the veins of the lower extremities is also aided by a muscle pump.

This means that the surrounding muscles - the calf muscles, which contract and relax again when moving, pump blood, which progresses further. Therefore, long-term inactivity and passivity, long sitting or standing are inappropriate.

The large veins of the lower limbs are located next to the large arteries. This placement also helps to expel blood as the large arteries contract rhythmically and relax.

And ...

Veins, the venous system of man is divided and in terms of deposit to:

  • deep - large veins, placed next to large arteries
  • superficial - smaller veins, collecting blood from tissues, which as a tangle then open into larger deep veins
  • connecting veins that connect the two vascular systems

A general introduction will help you orient yourself in a special section.

Want to know more about chronic venous insufficiency
What causes it
What are his symptoms
How is it treated and can it be prevented
Read on to us. 

What is it and how is chronic venous insufficiency defined?

The name suggests that this is a long-term venous insufficiency. The disease is progressive, so it progresses over time.

More precisely ...

It is a condition in which the return of venous blood from the lower limbs to the upper half of the body and heart is reduced, limited, weakened, or worsened.

The chronic course causes blood to accumulate in the lower limbs. As a result, a whole cascade of disease changes is triggered, which is responsible for a number of other difficulties.

These are subjective and objective. That is, those that one feels and those that can be observed from the outside.

Chronic venous insufficiency is classified as a disease of the circulatory system, which is a subtype of chronic venous disease.

Chronic venous disease CHVO (chronic venous disease of the lower extremities) - not the same as CHVI.

Chronic venous disease = a group of venous diseases.

Chronic venous insufficiency is a more serious form of chronic venous disease, including the presence of increased blood pressure in the venous system (DK) + complications resulting therefrom.

CHVO - a group of venous diseases. 
CHVI venous disease + venous hypertension DK + complications. 

The Hawaiian CEAP classification is used to assess venous insufficiency. The classification adopted in 1994 in the Hawaiian Islands by the American Venous Forum.

C = clinical - clinical symptoms, 
E = ethiology - cause, 
A = anatomy - anatomical location
P  = pathophysiology - pathophysiology, ie disorder of activity.

The table shows a more concise form of the CEAP classification

  • C0 = normal finding
  • C1 = telangiectasia
    • dilated small blood capillaries
    • so-called red threads in the subcutaneous tissue
  • C2 = varicose veins - varicose veins
  • C3 = edema - swelling
  • C4 = skin hyperpigmentation or swelling
    • hyperpigmentation is a change in skin color
  • C5 = healed forearm ulcer
  • C6 = active ongoing foreleg ulcer
  • + S = symptomatic form of the disease
  • + A = asymptomatic form of the disease
    • without the presence of manifestations
  • Ec - congenital = congenital origin
  • Ep - primary form
  • Es - secondary form
  • As - superficial = superficial veins
  • Ad - deep = deep venous system
  • Ap - perforated - vein connection system
  • Pr - with blood reflux 
  • After - with vessel obstruction 
  • Pr  + o = combination of both
  • Pn - unspecified form


The disease has a multifactorial cause. A combination of internal and external factors comes into contact here

CHVI - in MKCH (International Classification of Diseases) - I87.2.

On a closer look, it is a disorder of the return of blood from the lower limbs to the upper half of the body and to the heart. As a result, the blood pressure in the venous system rises.

It is said to be caused mainly by:

A. Blood reflux - venous reflux, the return flow of blood in the veins, which occurs as a result of a malfunction of the venous valves, and thus in the case of valve insufficiency.

Insufficient action due to the insufficiency of the valves will not completely close the vein. Blood returns to the lower parts of the vessel due to gravity, hence reflux. 

The cause is various disorders of the connective tissue, and therefore collagen or elastin and smooth muscle, but also inflammation of the veins, an example of which can be thrombophlebitis.

B. Obstruction, that is, an obstruction in the flow of blood, which can be, for example, venous thrombosis. And so a blood clot attaching to the vein wall.

C. Among others, it can be a muscle pump disorder when the muscles of the lower limbs are not helpful. This is also due to dysfunction of the calf muscles as a result of neuromuscular diseases.

And ...

Congenital venous anomalies are also a possible cause.

CHVI is divided into two basic types, namely:

  1. primary  - the  cause is unknown
  2. secondary  - the cause of the disease is known, examples are varices, inflammation, or thrombosis

In short, CHVI and blood circulation disorders cause:

  • the insufficient function of venous valves
  • primary varicose veins of the lower extremities
  • venous valve damage due to inflammation, thrombosis
  • venous endothelial dysfunction - the inner lining of the veins
  • microcirculation disorder

From a closer point of view, these are:

Long-term increased pressure in the veins has a negative effect on microcirculation. Small veins are destroyed over a long period of time. 

Microcirculation =
blood flow in the smallest vessels - capillaries,
at the site of metabolism between blood and tissues.

Through the process of the inflammatory cascade and the interaction of leukocytes with the endothelium, a number of changes occur, which culminate in damage not only to small vessels but also to the surrounding tissue.

The culmination of this story is the forefoot ulcer.

Schematically, the process can be described as:

Valve damage - reflux 
rebuilding walls of veins - varicose veins 
fault MACRO circulation and venous hypertension
impaired MICRO circulation 
accumulation of blood

swelling, skin changes ⇒
⇒ ulcer

And how is the relationship between CHVI and varicose veins?

It is reported that 70 to 90% of cases are associated with the presence of primary varicose veins associated with superficial and connective vein insufficiency.

The remaining 10 - 30% is attributed to vein thrombosis, ie venous thrombosis, and post-thrombotic syndrome

The most severe forms of CHVI occur in post-thrombotic syndrome.

PLUS ...

Various factors influence the development and progression of chronic venous insufficiency. These are either internal or external.

The multifactorial substrate includes a combination of various factors, such as:

  • heredity and genetic predisposition
  • older age
  • thrombosis and post-thrombotic syndrome
  • the presence of varicose veins
  • female gender 
  • hormonal changes
  • hormonal contraceptives
  • multiple pregnancies - two or more births
  • obesity and overweight
  • dressing style - tight clothes, high heels
  • smoking
  • poor lifestyle in general and improper diet
  • constipation, constipation - lack of fiber in the diet
  • injury and damage to blood vessels
  • walking on city pavement
  • overload and static overload
    • long sitting and sedentary lifestyle
    • long-standing
    • lack of movement, ie inactivity
      • cars have replaced walking
      • elevators, again walking up the stairs
      • sedentary job
      • work standing, without changing position


The symptoms of the disease are divided into two main groups, namely subjective and objective. Subjective are those that one feels. They are observed objectively from the outside.

Subjective difficulties that may occur:

  • feeling heavy legs
  • foot fatigue
  • pain in the lower limbs, lower leg
    • burning
    • pressure in the legs
    • feeling cold
    • torment
    • tingling
    • itching
    • increased sweating of the feet
    • restless legs syndrome
    • cramps in the legs, which start mainly at night

Objective symptoms include:

  • dilation of superficial veins  - telangiectasia
    • also known as  whisks, vascular threads in the subcutaneous tissue
    • corona phlebectatica - enlarged red, blue to purple veins on the inside of the ankle
  • swelling of the lower limbs, ankles, and forelegs
    • the swelling persists even when lying down or when the lower limbs are lifted
    • one-sided or one-sided highlighted
  • Varicose veins
  • skin changes
    • hyperpigmentation - browning of the skin
    • subcutaneous fibrosis
    • forearm ulcer

Evaluation of skin changes:

  1. degree - dilation of skin vessels, ie corona phlebectatica + swelling around the ankle
  2. degree - swelling of the lower limbskin changes in terms of hyperpigmentation, dermatosclerosis, skin inflammation, redness
  3. degree - forearm ulcer - ulcus cruris venosum

Foreleg ulcer

Also known as ulcer cruris known as Bércov ulcer.

A forefoot ulcer is a skin defect. It reaches into the depths of the skin to the subcutaneous tissue. 

It is a form of a chronic wound. Its treatment and healing are complicated and time-consuming.

It mostly occurs as a result of vascular damage due to chronic venous insufficiency, but also after phlebothrombosis.

Manifestations of forearm ulcer are:

  • deep defect
  • extensive skin damage
  • circular shape
  • irregular edges
  • the presence of exudation, ie inflammatory effusion
    • so-called wound wetting
  • coated defect base
  • swelling of the limb


History and clinical picture are important for diagnosis. The person concerned has a history of subjective difficulties. Family history and associated diseases are also important.

A person complains of pain, which can be of various natures, or increased fatigue and a feeling of heaviness in the legs.

The doctor then assesses the condition of the lower limbs. It is important to determine the presence of vasodilation, swelling, varicose veins, or, in the last stage, ulceration. It can already be overheated, but also in its active phase.

Among the imaging methods, Duplex sonography is important in the examination of the vessels of the lower limbs. This is a USG examination that evaluates the vascular system, plus color mapping of veins and blood flow.

And invasive venous pressure measurement is also used. This determines the presence of chronic venous insufficiency.

Furthermore, the mentioned CEAP classification is used in diagnostics for the overall evaluation of CHVI. This helps to determine the subsequent treatment strategy.


The course of the disease is lengthy. And its name implies that it is a chronic disease.

In addition, it is characterized by progression. This means that it gets worse over time.

Today's modern times bring comfortable solutions that do not always have a positive effect on our health.

The rate of movement decreases over time. Excessive sitting at home or at work and while traveling.

Plus, inappropriate diet combined with heredity and genetic predisposition. Over time, chronic venous insufficiency develops.

A good example is the women that have been encountered just a few risk factors. And therefore:

  1. hormonal changes
  2. contraceptive use plus smoking
  3. multiple multiple births
  4. sedentary work or, conversely, long-standing work,
  5. tight clothing and high heels
  6. later, older age or obesity
  7. other than heredity and genetic predisposition

1 + 2 + 3 + 4 + 5 + 6 + 7 = problem with name CHVI.

It is said that up to half of the population suffers from the disease, but not all of them are treated.

The period of
35-40 years affects: 7-35% of men and 20-60% of women. 
Ages over 60: 
15-55% of men and 40-78% of women. 

The exact course of the disease cannot be determined. However, if subjective difficulties occur, such as tired legs, a feeling of heaviness in them or night cramps, and swelling that does not respond to the elevated position, a doctor should be consulted.

Failure to do so in the long term can damage small blood vessels and impaired blood flow to the skin and subcutaneous tissue. This is a condition that leads to skin changes to an ulcer of the foreleg.

It heals long and problematic. In addition, a skin defect can be secondary to an infection, which again prolongs treatment.

Wondering how the prognosis works?

Early detection with early treatment of the disease can be achieved by limiting progression. So it doesn't have to end in a severe stage with an ulcer.

However, for a good result, a thorough cooperation and a confidential doctor-patient relationship is necessary.

How it is treated: Chronic venous

Treatment of chronic venous insufficiency: Medications and lifestyle change

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Interesting resources

  • The Lecturio Medical Concept Library
  • Patrick C Alguire, Barbara M Mathes. "Diagnostic evaluation of lower extremity chronic venous insufficiency". Retrieved 2017-09-12. Topic last updated: Dec 04, 2017.
  • Antignani, P. L. (August 2001). "Classification of chronic venous insufficiency: a review". Angiology. 52 Suppl 1: S17–26. 
  • Hafner, Jürg (1999-01-01). Management of Leg Ulcers. Karger Medical and Scientific Publishers. p. 81. ISBN 9783805566544.
  • Maryam Azhdari, Marzie Zilaee, Majid Karandish, Seyed Ahmad Hosseini, Anahita Mansoori, Mohadeseh Zendehdel, Sara Khodarahpour (2020). "Red Vine Leaf Extract (AS 195) Can Improve Some Signs and Symptoms of Chronic Venous Insufficiency, a Systematic Review". Phytotherapy Research34 (10): 2577–2585. 
  • Frick, RW (March 2000). "Three treatments for chronic venous insufficiency: escin, hydroxyethylrutoside, and Daflon". Angiology51 (3): 197–205. 
  • "Chronic Venous Insufficiency". hopkinsmedicine.org.
  • Mowatt-Larssen, Eric; Shortell, Cynthia (2010). "CHIVA". Seminars in Vascular Surgery23 (2): 118–22.