Chronic venous insufficiency
Encyclopedia
Chronic venous insufficiency or CVI is a medical condition where the veins cannot pump enough oxygen-poor blood back to the heart. It is sometimes referred to as an "impaired musculovenous pump", this is due to damaged or "incompetent" valves as may occur after deep vein thrombosis
(when the disease is called postthrombotic syndrome) or phlebitis
. Paratroopers, utility pole linemen, and men with leg injuries can suffer from damaged leg vein valves and develop this condition. Ordinarily, women make up the largest demographic for this problem.
and cellulitis
. The condition has been known since ancient times and Hippocrates used bandaging to treat it. It is better described as chronic peripheral venous insufficiency.
Venous valve incompetence is treated conservatively with manual compression lymphatic massage therapy, skin lubrication, sequential compression pump, ankle pump, compression stockings, blood pressure medicine, frequent periods of rest elevating the legs above the heart level and using a 20 cm (7-inch) bed wedge during sleep. Surgical treatments include the old Linton procedures and the newer subfascial endoscopic perforator vein surgery. Some experimental valve repair or valve transposition procedures as well as some hemodynamic surgeries are being pursued. This whole field of medicine while ancient is still filled with complications e.g. Sometimes an artery can strangulate a vein or sometimes an arteriovenous fistula (an abnormal connection or passageway between an artery and a vein) may be causing the apparent poor venous return.
Patients are often encouraged to walk while wearing the prescribed medical stockings and to sleep in a 6 degree Trendelenburg position
. Obese or pregnant patients might be advised by their physicians to forgo the tilted bed.
Surprisingly, leech therapy long ago abandoned by medicine, can actually be beneficial treatment. The leeches draw out the excess venous blood that has CO2 and metabolic wastes in a measured amount with little danger of dropping the blood volume.
(CCSVI). It can be seen using Transcranial doppler
sonography or MRV
(magnetic resonance venography)
This disease was only recently described (2006) and the first international symposium took place on September 8, 2009 in Bologna
, Italy
. The causes of venous insufficiencies were discussed, and it was mostly shown that it is due to venous stenosis
which is subsequently due to genetics or embryonic problems.
The known consequences of the disease are hypoxia
, delayed perfusion
and iron
deposits in the blood vessels, with unknown final effects for the health of the patients. A connection with MS
has been proposed (all cases of CCSVI were found in MS patients) but the possible relationship is still under study.
It can be treated currently in two ways: Balloons
to open the veins, in the hope they will remain open, and venous stents
, to keep them open permanently.
Other research groups have found jugular veins reflux in other neurological diseases. In particular in Transient Global Amnesia, Leukoaraiosis, and general myelopathies. All of them have been linked to venous reflux with different names like Cerebral Venous Outflow Impairment. At this moment is unknown if these conditions can be considered related to CCSVI.
of the hepatic veins. It presents with the classical triad of abdominal pain, ascites
and hepatomegaly
. Examples of occlusion include thrombosis of hepatic veins. The syndrome can be fulminant, acute, chronic, or asymptomatic. It occurs in 1 out of a million individuals and is more common in females. Some 10–20% also have obstruction of the portal vein.
Any obstruction of the venous
vasculature of the liver is referred to as Budd-Chiari syndrome, from the venule
s to the right atrium
. This leads to increased portal vein and hepatic sinusoid pressures as the blood flow stagnates. The increased portal pressure causes: 1) increased filtration of vascular fluid with the formation of protein-rich ascites in the abdomen; and 2) collateral venous flow through alternative veins leading to gastric varices and hemorrhoids. Obstruction also causes centrilobular necrosis and peripheral lobule fatty change due to ischemia. If this condition persists chronically what is known as Nutmeg liver
will develop. Renal failure may occur, perhaps due to the body sensing an "underfill" state and subsequent activation of the renin-angiotensin pathways and excess sodium retention.
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
(when the disease is called postthrombotic syndrome) or phlebitis
Phlebitis
Phlebitis is an inflammation of a vein, usually in the legs.When phlebitis is associated with the formation of blood clots , usually in the deep veins of the legs, the condition is called thrombophlebitis...
. Paratroopers, utility pole linemen, and men with leg injuries can suffer from damaged leg vein valves and develop this condition. Ordinarily, women make up the largest demographic for this problem.
Venous insufficiency in the legs
As functional venous valves are required to provide for efficient blood return from the lower extremities, CVI often occurs in the veins of the legs. Itching (pruritis) is sometimes a symptom, along with hyperpigmentation of the legs. Symptoms of CVI include phlebetic lymphedema and chronic swelling of the legs and ankles. The skin may react with varicose eczema, local inflammation, discoloration, thickening, and an increased risk of ulcersVenous insufficiency ulceration
Venous insufficiency ulceration, as well as stasis dermatitis, is a skin condition that results from increased pressure in the venous system of the lower leg.- See also :* Arterial insufficiency ulcer* List of cutaneous conditions* Venous ulcer...
and cellulitis
Cellulitis
Cellulitis is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters,...
. The condition has been known since ancient times and Hippocrates used bandaging to treat it. It is better described as chronic peripheral venous insufficiency.
Venous valve incompetence is treated conservatively with manual compression lymphatic massage therapy, skin lubrication, sequential compression pump, ankle pump, compression stockings, blood pressure medicine, frequent periods of rest elevating the legs above the heart level and using a 20 cm (7-inch) bed wedge during sleep. Surgical treatments include the old Linton procedures and the newer subfascial endoscopic perforator vein surgery. Some experimental valve repair or valve transposition procedures as well as some hemodynamic surgeries are being pursued. This whole field of medicine while ancient is still filled with complications e.g. Sometimes an artery can strangulate a vein or sometimes an arteriovenous fistula (an abnormal connection or passageway between an artery and a vein) may be causing the apparent poor venous return.
Patients are often encouraged to walk while wearing the prescribed medical stockings and to sleep in a 6 degree Trendelenburg position
Trendelenburg position
In the Trendelenburg position the body is laid flat on the back with the feet higher than the head by 15-30 degrees, in contrast to the reverse Trendelenburg position, where the body is tilted in the opposite direction. This is a standard position used in abdominal and gynecological surgery...
. Obese or pregnant patients might be advised by their physicians to forgo the tilted bed.
Surprisingly, leech therapy long ago abandoned by medicine, can actually be beneficial treatment. The leeches draw out the excess venous blood that has CO2 and metabolic wastes in a measured amount with little danger of dropping the blood volume.
May-Thurner syndrome
In medicine, May-Thurner syndrome is a rare condition in which blood clots, called deep venous thrombosis (DVT), occur in the iliofemoral vein due to compression of the blood vessels in the leg. The specific problem is compression of the left common iliac vein by the overlying right common iliac artery. This leads to pooling or stasis of blood, predisposing the individual to the formation of blood clots.Venous insufficiency in the central nervous system
CVI has been reported in the CNS of several persons. When it appears into the CNS is called Chronic cerebrospinal venous insufficiencyChronic cerebrospinal venous insufficiency
Chronic cerebrospinal venous insufficiency is a term developed by Italian researcher Paolo Zamboni in 2008 to describe compromised flow of blood in the veins draining the central nervous system...
(CCSVI). It can be seen using Transcranial doppler
Transcranial doppler
Transcranial Doppler is a test that measures the velocity of blood flow through the brain's blood vessels. Used to help in the diagnosis of emboli, stenosis, vasospasm from a subarachnoid hemorrhage , and other problems, this relatively quick and inexpensive test is growing in popularity in the...
sonography or MRV
Magnetic Resonance Angiography
Magnetic resonance angiography is a group of techniques based on Magnetic Resonance Imaging to image blood vessels. Magnetic resonance angiography is used to generate images of the arteries in order to evaluate them for stenosis , occlusion or aneurysms...
(magnetic resonance venography)
This disease was only recently described (2006) and the first international symposium took place on September 8, 2009 in Bologna
Bologna
Bologna is the capital city of Emilia-Romagna, in the Po Valley of Northern Italy. The city lies between the Po River and the Apennine Mountains, more specifically, between the Reno River and the Savena River. Bologna is a lively and cosmopolitan Italian college city, with spectacular history,...
, Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
. The causes of venous insufficiencies were discussed, and it was mostly shown that it is due to venous stenosis
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
which is subsequently due to genetics or embryonic problems.
The known consequences of the disease are hypoxia
Hypoxia (medical)
Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...
, delayed perfusion
Perfusion
In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. The word is derived from the French verb "perfuser" meaning to "pour over or through."...
and iron
Human iron metabolism
Human iron metabolism is the set of chemical reactions maintaining human homeostasis of iron. Iron is an essential element for most life on Earth, including human beings. The control of this necessary but potentially toxic substance is an important part of many aspects of human health and disease...
deposits in the blood vessels, with unknown final effects for the health of the patients. A connection with MS
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
has been proposed (all cases of CCSVI were found in MS patients) but the possible relationship is still under study.
It can be treated currently in two ways: Balloons
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
to open the veins, in the hope they will remain open, and venous stents
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
, to keep them open permanently.
Other research groups have found jugular veins reflux in other neurological diseases. In particular in Transient Global Amnesia, Leukoaraiosis, and general myelopathies. All of them have been linked to venous reflux with different names like Cerebral Venous Outflow Impairment. At this moment is unknown if these conditions can be considered related to CCSVI.
Venous insufficiency in the liver
Budd–Chiari syndrome is the condition caused by occlusionVascular occlusion
Vascular occlusion is a sudden blockage of a blood vessel, usually with a clot. It differs from thrombosis in that it can be used to describe any form of blockage, not just one formed by a clot. When it occurs in a major vein, it can, in some cases, cause deep vein thrombosis. The condition is...
of the hepatic veins. It presents with the classical triad of abdominal pain, ascites
Ascites
Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver...
and hepatomegaly
Hepatomegaly
Hepatomegaly is the condition of having an enlarged liver. It is a nonspecific medical sign having many causes, which can broadly be broken down into infection, direct toxicity, hepatic tumours, or metabolic disorder. Often, hepatomegaly will present as an abdominal mass...
. Examples of occlusion include thrombosis of hepatic veins. The syndrome can be fulminant, acute, chronic, or asymptomatic. It occurs in 1 out of a million individuals and is more common in females. Some 10–20% also have obstruction of the portal vein.
Any obstruction of the venous
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
vasculature of the liver is referred to as Budd-Chiari syndrome, from the venule
Venule
A venule is a very small blood vessel in the microcirculation that allows deoxygenated blood to return from the capillary beds to the larger blood vessels called veins. Venules range from 8 to 100μm in diameter and are formed when capillaries unite .Venules are blood vessels that drain blood...
s to the right atrium
Right atrium
The right atrium is one of four chambers in the hearts of mammals and archosaurs...
. This leads to increased portal vein and hepatic sinusoid pressures as the blood flow stagnates. The increased portal pressure causes: 1) increased filtration of vascular fluid with the formation of protein-rich ascites in the abdomen; and 2) collateral venous flow through alternative veins leading to gastric varices and hemorrhoids. Obstruction also causes centrilobular necrosis and peripheral lobule fatty change due to ischemia. If this condition persists chronically what is known as Nutmeg liver
Nutmeg liver
In hepatology, congestive hepatopathy, also known as nutmeg liver and chronic passive congestion of the liver, is liver dysfunction due to venous congestion, usually cardiac dysfunction, i.e...
will develop. Renal failure may occur, perhaps due to the body sensing an "underfill" state and subsequent activation of the renin-angiotensin pathways and excess sodium retention.
See also
- Atrophie blanche
- Chronic cerebrospinal venous insufficiencyChronic cerebrospinal venous insufficiencyChronic cerebrospinal venous insufficiency is a term developed by Italian researcher Paolo Zamboni in 2008 to describe compromised flow of blood in the veins draining the central nervous system...
- Compression stockingsCompression stockingsCompression stockings and socks are specialised hosiery items designed to increase blood circulation. Their main theraputic purpose is to provide graduated pressure on the lower leg and foot and, in some cases, the thigh, to alleviate circulatory problems such as edema, phlebitis and...
- Heavy legsHeavy legsHeavy legs is an alleged medical condition, described as an "unpleasant sensation of pain and heaviness" in the lower limbs. It is recognised primarily in France, and to a lesser extent elsewhere....
- Linton flap
- LipodermatosclerosisLipodermatosclerosisLipodermatosclerosis is a skin and connective tissue disease. It is a form of lower extremity panniculitis, an inflammation of the layer of fat under the epidermis.- Symptoms :Pain may be the first noticed symptom...
- May-Thurner syndromeMay-Thurner syndromeIn medicine, May-Thurner syndrome is a rare condition in which blood clots, called deep venous thrombosis , occur in the iliofemoral vein due to compression of the common venous outflow tract of the left lower extremity. The specific problem is compression of the left common iliac vein by the...
- Musculovenous pump
- Thoracic outlet syndromeThoracic outlet syndromeThoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene...
- Varicose veinsVaricose veinsVaricose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards . Leg muscles pump the veins to return blood to the heart, against the...
- Vascular myelopathyVascular myelopathyVascular myelopathy refers to an abnormality of the spinal cord in regards to its blood supply. The blood supply is complicated and supplied by two major vessel groups: the posterior spinal arteries and the anterior spinal arteries—of which the Artery of Adamkiewicz is the largest...
- VenographyVenographyVenography is a procedure in which an x-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure...
- Venous stasis ulceration
- Venous stasisVenous stasisVenous stasis, or venostasis, is a condition of slow blood flow in the veins, usually of the legs. A patient with venous stasis might be more vulnerable to the formation of blood clot, especially in the deep veins of the legs, called deep vein thrombosis .Causes include long periods of immobility...
- Venous ulcerVenous ulcerVenous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are the major cause of chronic wounds, occurring in 70% to 90% of chronic wound cases...
- Superior vena cava syndromeSuperior vena cava syndromeSuperior vena cava syndrome , or superior vena cava obstruction , is usually the result of the direct obstruction of the superior vena cava by malignancies such as compression of the vessel wall by right upper lobe tumors or thymoma and/or mediastinal lymphadenopathy. The most common malignancies...
- Chronic venous congestionChronic venous congestionVenous congestion is the dilation of veins and capillaries due to impaired venous drainage which results in passive hyperaemia or venous congestion, commonly referred to as congestion...