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Chronic Venous Insufficiency

Chronic venous insufficiency of the lower extremities affects up to 
5% of people in the United States and is most often diagnosed in women ages 40 to 49 and men ages 70 to 79. Many cases of chronic venous insufficiency can be managed with accurate diagnosis and advanced, minimally invasive treatments.

Chronic venous insufficiency implies a functional abnormality of the venous system, and the term is usually reserved for more advanced cases associated with skin manifestations. These advanced venous conditions are ranked Class 4, Class 5 or Class 6 on the clinical, etiologic, anatomic, pathophysiologic (CEAP) classification scale. Chronic venous insufficiency occurs frequently, but its manifestations may go unrecognized. Although some providers may consider spider veins or varicose veins to primarily be an aesthetic problem, patients who have developed chronic venous insufficiency can face life-altering symptoms that affect a person’s ability to work and perform daily activities.

Chronic venous insufficiency extends beyond spider veins or varicose veins and will not resolve if left untreated. One of the most common signs of the condition is inflammation occurring in the gaiter region of the legs, particularly around the ankles. This symptom is often representative of a CEAP Class 3 patient and can develop into hyperpigment changes of the skin. The area surrounding the ankles may become tight, brown or cause pain, which would be classified as CEAP Class 4. If the symptoms are allowed to continue unabated, an individual may suffer from open sores that heal in the lower extremities — CEAP Class 5 — and sores that do not heal — CEAP Class 6.

“Venous problems are always progressive and do not improve unless they are treated properly,” says Primepares Pal, M.D., Registered Physician in Vascular Interpretation at Minnesota Vein Center, P.A. “Individual patients may experience changes or increases in CEAP classification, and the progression of the condition occurs on a case-by-case basis.”

Following the CEAP Scale

To assess and diagnose venous conditions, CEAP classification – which stands for clinical, etiologic, anatomic and pathophysiologic – categorizes symptoms into 6 levels:

  • Class 1: minor reticular and spider veins
  • Class 2: varicose veins
  • Class 3: ankle swelling caused by congestion in the veins (varicose veins)
  • Class 4: changes in the skin, such as stasis dermatitis and lipodermatosclerosis, resulting in discoloration and inflammation
  • Class 5: possible tissue hypoxia, which can lead to venous ulcers; venous ulcers that have healed
  • Class 6: open venous ulcers

Seeking Appropriate Methods

Early signs of chronic venous insufficiency may include reddish coloring over the medial or lateral part of the ankle — related to high pressure developing in the ankle area — or outbursts of vein pigmentation that appear to be spider veins near the ankles (corona phlebectatica). If patients attempt to seek treatment solely through cosmetic laser or injection procedures, the veins will not be eliminated, and a serious condition can remain undiagnosed. Some people may continue for months or years without receiving effective treatment, which can have a significant impact on their health, quality of life and socioeconomic status.

“When patients present with signs of chronic venous insufficiency, recognizing the early stages of the condition may prevent more serious complications,” 
Dr. Pal says. “These days, there are effective minimally invasive endovascular treatments that can be completed in the office, allowing the patient to return home or to work almost immediately.”

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