Chronic Venous Insufficiency

Blood circulates in the human body. But when the valves located in the veins are damaged or lacking, the blood may not return normally to the heart. It pools in the legs and complications ensue. This condition is termed chronic venous insufficiency (CVI). ^[1]

Epidemiology

A person has a greater chance of developing CVI with advancing age. Usual age range is 70 to 79 for males and 40 to 49 for females. The condition is thought to be more common in Western and industrialized countries than developing ones. ^{[2] [3]}

Causes

Veins are structures likened to highways as blood passes through it from the body organs back to the heart. To be able to arrive at the heart, the blood has to run upward from the veins in the legs. For blood not to back down, one-way valves contained in the veins are necessary. In CVI, these valves are insufficient, weakened or damaged.

The damage in the valves may be brought about by several factors such as aging, prolonged sitting or standing or reduced mobility. A condition called Deep Vein Thrombosis wherein there is a blood clot in leg veins is a disease that may predispose an individual to CVI.  Tumors, vascular malformations, injuries and surgeries can also cause CVI to develop. Smoking is also suggested as a possible etiology.  ^{[2] [4]} Risk factors include obesity, pregnancy and positive family history of CVI. ^[5]

Signs and Symptoms

Symptoms of CVI include leg or ankle swelling and pain in the affected area. The pain may be felt while walking and may be relieved by rest. There can be discoloring of the skin especially near the ankles that may look leathery or flaky. The person can also develop varicose veins and leg ulcers that heal slowly. ^{[4] [5]}

Diagnosis

Medical history and physical examination are important to arrive at suspicion of CVI. The condition can be accurately diagnosed thru duplex ultrasound or magnetic resonance venography. ^[5]

Treatment

If the symptoms are not incommodious for the patient, medical intervention may not be needed. On the other hand if treatment is indispensable, the focus is on exercise, elevating the legs and elastic compression. If these are not enough, other treatment options are available like radiofrequency closure, endovenous laser therapy, angioplasty and stent placement. Depending on the case, surgery may be done.

References:

1.      http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/venous-disorders/chronic-vd.shtml

2.      http://surgery.med.miami.edu/vascular-and-endovascular/patient-care-services/chronic-venous-insufficiency

3.      http://emedicine.medscape.com/article/1085412-overview#a0156

4.      http://my.clevelandclinic.org/disorders/venous_insufficiency/hvi_chronic_venous_insufficiency.aspx

5.      http://www.ucdmc.ucdavis.edu/vascular/diseases/cvi.html

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Pine Bark Extract [1, 8, 9, 10]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: weakly in favor  (Early studies indicate potential for Pine bark extract in the treatment of Chronic Venous Insufficiency, but more clinical studies need to be done)

Grade of Evidence: low quality of evidence

Gotu Kola (Centella Asiatica, Hydrocotyle Asiatica)[1, 2, 3, 4, 5, 6, 7]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor(A few clinical trials have shown that Gotu Kola may be helpful in reducing the effects of venous insufficiency. However, further research is needed)

Grade of Evidence: low quality of evidence

Horse-Chestnut Seed Extract (HCSE) [11, 12, 13, 14]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Studies have shown that horse-chestnut seed extract may be able to treat short-term chronic venous insufficiency)

Grade of Evidence: Moderate quality of evidence

* www.gradeworkinggroup.org