By David E. Allie, M.D.
Chief of Cardiothoracic and Vascular Surgery
Cardiocascular Institute of the South /Lafayette

Chronic venous insufficiency (CVI) is a leg vein problem that causes decades of increasing pain and disability for many thousands of people, the majority of them women. But recently developed surgical techniques can alleviate the problem for many of its sufferers.

The legs have two separate systems of veins through which blood makes its return trip to the heart. The first system, deep within the leg, carries blood at a higher pressure than do the superficial veins closer to the skin. There is normally very little blood flow between these two systems, though small veins, called "perforators", do link them, providing a means for bleeding off excess pressure within the deep venous system.

In order to reduce the pumping force needed to return blood to the heart, veins contain valves which allow the blood to move easily upward toward the heart, but prevent it from flowing backward between pumping phases of the heartbeat.

In CVI patients,. damage to these valves from injury, blood clots, or a congenital weakness of the valves raises the pressure in the deep veins of the leg significantly. The perforators are forced to constantly bleed off pressure by sending more blood from the deep veins to the superficial system. In time, they become permanently distended and the pressure in the superficial system never returns to normal. The result is constant swelling, chronic pain, varicose veins and a progressive degeneration and thickening of the skin near the ankle which leads, ultimately, to serious and virtually incurable ulcers. in the worst cases, these ulcers can become infected, gangrene can set in and amputation may be required to save the patient's life.

The usual treatment in the early stages of CVI is elastic stocking to apply external pressure to the system and dressings and salves to treat the ulcers. The only treatment for advanced stages of the disease was surgery to tie off the perforator veins to relieve the pressure in the superficial system -- pressure patients describe as making the leg feel like it is about to explode.

Now, however, techniques have been developed which permit vascular surgeons to either repair damaged valves in the large veins of the upper leg, or to bypass them using a length of vein with healthy valves from somewhere else in the body. Only one or two key valves must be restored to normal function to return pressures in the system to normal.

To date, however, only a fairly small percentage of the vascular surgeons competent to perform the operation have become familiar with it. This is unfortunate, given the lifetime of misery CVI can cause those it afflicts, and the relief the surgery bestows, both from the condition's chronic pain and all but incurable leg ulcers.

&copy 1995 Cardiocascular Institute of the South

For further information, call Jane Arnette, Cardiocascular Institute of the South /Houma, 1-800-425-2565, or Jim Keyser at 1-800-848-2715. E-mail questions or comments to: jakeyser@cardio.com .

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