Chronic Venous Insufficiency (CVI): Symptoms, Causes and UK Management

Chronic Venous Insufficiency (CVI) is a long-term condition where the valves in the leg veins do not work effectively. In a healthy circulatory system, these valves ensure that blood flows upwards toward the heart. When they become damaged or weakened, blood can pool in the lower legs, a process known as venous stasis.

In the UK, CVI is a common cause of morbidity, particularly among older adults and those with a history of deep vein thrombosis (DVT). It is not merely a cosmetic issue; if left untreated, the increased pressure within the veins can lead to significant skin damage and painful ulceration. Understanding the early signs is essential for maintaining mobility and skin integrity.

The symptoms of Chronic Venous Insufficiency often develop gradually. Patients frequently report that their legs feel 'heavy' or 'tired,' particularly at the end of the day or after long periods of standing. Key symptoms to monitor include:

• Oedema: Swelling in the ankles and lower legs that often improves overnight or when legs are elevated.
• Aching and Cramping: A dull ache or throbbing sensation, often accompanied by nighttime leg cramps.
• Skin Changes: The skin may become discoloured (hyperpigmentation), appearing reddish-brown or 'rusty.'
• Varicose Eczema: Itchy, flaky, or red skin on the lower legs, often caused by blood leaking into the surrounding tissue.
• Lipodermatosclerosis: A condition where the skin and the fat underneath become hard and tight, sometimes making the leg look like an 'inverted champagne bottle.'

CVI is primarily caused by high pressure in the leg veins (venous hypertension). Several factors can contribute to this, according to NHS clinical observations. A primary cause is a previous DVT, which can damage the delicate valves within the vein, leading to 'post-thrombotic syndrome.'

Other significant risk factors include:

• Age: Vein walls and valves naturally weaken over time.
• Obesity: Excess weight puts significant pressure on the veins in the lower body.
• Pregnancy: Hormonal changes and increased blood volume can strain the venous system.
• Occupation: Jobs that require prolonged standing or sitting without movement (e.g., retail or office work).
• Family History: Genetics plays a role in the structural integrity of vein valves.

The management of CVI focuses on reducing venous pressure and improving circulation. NICE (National Institute for Health and Care Excellence) guidelines emphasise conservative management as the first line of treatment for many patients.

Compression Therapy

Compression stockings are the cornerstone of CVI management. They apply graduated pressure to the leg, helping the vein valves function and pushing blood back toward the heart. It is vital to have these professionally fitted to ensure they are the correct grade and size.

Physical Activity

Walking is particularly beneficial as it engages the calf muscle pump, which is essential for venous return. Simple ankle flexes while sitting can also help prevent blood from pooling.

Leg Elevation

Elevating your legs above the level of your heart for 30 minutes, three to four times a day, can significantly reduce oedema and improve comfort.

One of the most serious complications of untreated CVI is the development of venous leg ulcers. These are chronic sores that occur when high pressure causes fluid to leak out of the veins, damaging the skin until it breaks down. These ulcers can take months to heal and are prone to infection.

Regularly moisturising the skin with emollients can help maintain the skin barrier and prevent the cracking associated with varicose eczema, reducing the risk of ulceration. If you notice a break in the skin that does not heal within two weeks, you must seek medical advice immediately.

Managing a long-term condition like Chronic Venous Insufficiency can be challenging, but you can speak to a GP online for guidance and support. An online consultation is a convenient way to discuss your symptoms and receive a management plan without leaving home.

You should consider booking an appointment if:

• Your leg swelling is persistent and does not improve with elevation.
• You are experiencing itchy or painful skin changes on your lower legs.
• You need advice on the correct type of compression hosiery.
• Your symptoms are impacting your daily activities or sleep.

Our clinical team can review your history, assess your symptoms via video or photos, and provide private prescriptions or referrals if further diagnostic tests, such as a duplex ultrasound, are required.