What are the negative health effects of chronic venous insufficiency (CVI)?

Negative Health Effects of Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) causes significant morbidity including pain, edema, skin changes, ulceration, and substantially reduced quality of life that can be worse than conditions such as osteoarthritis, angina, and chronic lung disease. 1

Symptoms and Clinical Manifestations

Common Symptoms

• Pain and discomfort (aching, burning, heaviness, fatigue)
• Swelling (edema) that worsens with prolonged standing
• Itching and tingling
• Cramping (often at night)
• Venous claudication (bursting leg pain during exercise)
• Restlessness in the legs 1

These symptoms typically:

• Worsen by the end of the day
• Are exacerbated by prolonged standing or walking
• Improve with rest or leg elevation 1

Skin and Tissue Changes

• Hyperpigmentation (brownish discoloration)
• Telangiectasias (spider veins)
• Venous ectasia and varicose veins
• Edema
• Dermatitis and eczema
• Lipodermatosclerosis (hardening of the skin and subcutaneous tissues)
• Atrophie blanche (white atrophic skin with telangiectasias)
• Venous ulceration 1, 2

Progression and Classification

CVI severity is commonly classified using the CEAP system (Clinical, Etiologic, Anatomic, Pathophysiologic):

• C0: No visible signs
• C1: Telangiectasias or reticular veins
• C2: Varicose veins
• C3: Edema
• C4a: Pigmentation or eczema
• C4b: Lipodermatosclerosis or atrophie blanche
• C5: Healed venous ulcer
• C6: Active venous ulcer 1

The prevalence of these stages in the general population is approximately:

• C0-C1: 29% each
• C2: 23%
• C3: 10%
• C4: 9%
• C5: 1.5%
• C6: 0.5% 1

Impact on Quality of Life

CVI significantly impacts quality of life:

• Physical quality of life for patients with postthrombotic syndrome (a form of CVI) is worse than for patients with chronic diseases such as osteoarthritis, angina, and chronic lung disease 1
• The Dermatology Life Quality Index (DLQI) shows that nearly 90% of patients experience moderate to very large impact on their quality of life 3
• Psychological effects include anxiety and depression 2
• Sleep disturbances are common 4
• Patients may experience absenteeism from work and disability 4

Complications

Venous Ulceration

• Most chronic leg ulcers (nearly 1%) are venous in origin 1
• Ulcers are often recurrent and difficult to heal
• Venous ulcers are the most severe manifestation of CVI 1, 2

Other Complications

• Contact dermatitis (more common in CVI patients due to disrupted epidermal barrier)
• Superficial thrombophlebitis
• Infection of ulcers or damaged skin
• Rare but serious external hemorrhage from perforation of varicose veins
• Malignant degeneration in chronic ulcers (rare but aggressive) 1, 2

Socioeconomic Impact

CVI carries a substantial economic burden:

• Treatment costs for postthrombotic syndrome estimated at approximately $7,000 per patient per year 1
• Total treatment costs for venous ulcerative disease exceed $2.5 billion annually in the United States 1
• First-year costs for severe postthrombotic syndrome with open ulcers: $3,817 per patient 1
• Approximately 2 million workdays are lost annually in the US due to leg ulcers 1
• Patients with CVI, especially those with skin changes, frequently seek emergency care for their symptoms 4

Pathophysiology

The central mechanism of CVI is venous hypertension resulting from:

• Valvular incompetence (reflux)
• Venous obstruction
• Muscle pump dysfunction
• Or a combination of these factors 5

This leads to a cascade of events:

1. Increased venous pressure
2. Venous stasis
3. Inflammatory response
4. Damage to venous walls and valves
5. Progressive worsening of symptoms and tissue damage 1

Understanding these negative health effects is crucial for early intervention, as prompt treatment can prevent progression to more severe stages and complications of CVI.