Are you in a job that requires you to sit for long hours or stand at length? Or a public figure, a political leader or a corporate honcho who needs to make courtesy gestures like shaking hands frequently all through the day, either at events, on public podiums or in official meetings. Chances are high that you might get varicose veins with blood clots or poor circulation. If the problem persists, it can take a severe and deeper turn, aggravating into the condition known as Chronic Venous Insufficiency (CVI).
Eye on CVI
What is Chronic Venous Insufficiency after all? “CVI is a long-term condition wherein the veins (primarily of the legs) can no longer effectively transport blood back to the heart. Under normal circumstances, one-way valves within veins help the blood flow upwards against gravity. But when the same becomes weak or damaged, blood leaks backward and starts to pool in the veins. This causes swelling, pain and noticeable changes in the skin tone and texture over time in the affected parts,” explains Dr Vishalakshi Vishwanath, consultant dermatologist, KIMS Hospitals in Thane.
Dermatologist Dr Prateek Sondhi, director at Derma Circles, adds that “due to malfunctioning of the small valves, blood accumulates in the legs causing heaviness, ulcers and sometimes darkening of the skin colour.”
Human body’s lower limbs have multiple valves, which “prevent blood from streaming downward as they are unidirectional”. “However, in CVI, these valves become faulty and incompetent as they induce venous reflux, triggering blood deposition and increased venous pressure in the legs,” notes vascular and endovascular surgeon Dr. Simit Vora.
Dr Gagandeep Singh, lifestyle medicine and diabetes reversal expert at Redial Clinic, imparts that “as the debilitating veins struggle hard to push blood northwards to the heart, gravity draws the blood southward causing it to pile up and develop raised, twisted varicose veins, cramps, etc.”
The only proper antidote to this malaise is “movement”, she suggests. “The calf and thigh muscles act as a natural ‘second heart,’ squeezing the veins and pumping blood upwards,” she enlightens.
Occupational hazards
Many jobs involve risk factors like being stationed at one position or remaining confined to the same place for long hours. Plus, faulty postures may induce blood collection in the veins. “Such daily duties put a constant strain on leg veins. For example, traffic cops, teachers, retail workers and nurses stand at one place for long periods of time, while office workers, drivers and telephone operators have to sit for the majority of their work schedules. In both cases, blood flow is limited and that restricts the veins to push blood efficiently. In fact, simply sitting crossed legged for too long can intensify the situation,” reports Dr Vishwanath.
Alerts for obesity and pregnancy
Why are plump individuals and expecting women susceptible to this condition?
“Excess body weight, whether due to flawed body habits or pregnancy, causes fat buildup in the lower body veins. Hormonal changes as well as expansion of the uterus while carrying allows less blood flow, spurring immense difficulty for the veins to function against gravity. Consequently, bumps, pangs and venous congestion are more likely to ensue,” reasons Dr Vishwanath.
In jeopardy
People with specific health issues are prone to get affected by CVI. Individuals with a history of deep vein thrombosis (DVT), varicose veins or family episodes of venous concerns are in maximum peril. Lethargic people, smokers and elderly adults are also vulnerable because their circulation and vein health deteriorate naturally over the years.
Is cure for sure?
Sad but true, CVI is not completely curable because the damaged valves in the veins cannot be repaired naturally. “But it can be very well controlled with treatment. Modern methods can close the damaged veins and enable the blood to drift through healthy channels instead. This aids in achieving excellent long-term relief,” confirms Dr Sondhi.
“Treatments control symptoms and prevent advancement but cannot restore normal valve function. In a nutshell, it stops the ongoing slow progression of the disease rather than reversing the signs, which have already taken root. Minimally-invasive procedures (like laser treatment) seal the invalid veins by rerouting blood through their healthy counterparts. This alleviates symptoms but doesn’t halt the underlying tendency of triggering venous issues. Thus, long-run management and lifestyle measures are key to deterring the recurrence of such maladies,” he informs.
CVI management
Regular activity, weight management, raising the legs and wearing compression stockings are some handy options. “These promote circulation and help abate swelling. In extreme cases, the medical experts may even remove the affected, defunct veins to improve the blood flow,” volunteers Dr Vishwanath.
Lifestyle changes like walking daily, weight control, avoiding long standing/sitting, leg elevation, slipping on special snug-fitting compression socks can make a huge difference. Additionally, medicines offer some relief. If symptoms stay critically, then doctors may opt for a surgical procedure using minimally-invasive techniques, namely •laser treatment (EVLA) •radiofrequency ablation (RFA) •sclerotherapy (injecting medicines to close the defective veins).
Simple exercises like brisk walking, cycling, ankle pumps, stair climbing and short bouts of squats can dramatically improve circulation. Even 10-15 minutes of taking steps a few times a day helps. For people who sit or stand for long hours, a break after every 45-60 minutes to stretch and walk is imperative. That could be a real game changer in speeding up recovery!
EVLA decoded
Endovenous Laser Ablation (EVLA) is a new, minimally-invasive technique that treats damaged veins with laser energy. “A small fibre is passed into the pursued vein while controlled heat closes it. Blood is then forced to pass through healthier veins. It’s a fast, safe procedure with quicker recovery than any given conventional vein surgery,” elucidates Dr Vishwanath.
In simple terms, the doctor uses ultrasound to identify the faulty vein and accesses it by a small tube (sheath). A thin fibre is inserted in the vein via a tiny opening in the skin. Laser energy is then transmitted through the fibre and the heat generated shuts the bad vein permanently. Blood automatically starts running through healthier veins.
“Good news is that no major cuts or incisions are required in this surgical procedure. It is usually done under local anesthesia and the concerned patient is discharged the same day,” raves Dr Sondhi.
This ultrasono-guided technique blocks inept superficial veins (the two largest in the legs, commonly called the great and short saphenous veins responsible for draining deoxygenated blood from the feet and legs back to the heart).
Precautions
Proper care is taken during post-treatment phase and beyond to enable patients to return to their everyday lifestyle quite quickly:
Wear compression stockings in daytime for about 1-2 weeks
Avoid prolonged standing/sitting
Walk regularly (at least 4 times a day for 15 mins each) to promote circulation
Avoid strenuous exercise or heavy lifting of weights
Maintain healthy body weight and leg elevation when resting
Outcome: Pain relief, dwindled swelling and improved skin changes occur within a few weeks to months.
