Chronic Venous Insufficiency (CVI)
CVI is a progressive medical condition that may worsen over time and affects the veins and vessels in the leg that carry oxygen-poor blood back toward the heart. CVI signs and symptoms may include pain, swelling and fatigue of the legs as well as skin damage and ulcers. CVI is often preceded by varicose veins.¹
Leg Vein Anatomy
The leg venous system comprises a network of veins, including:
Superficial venous system: Veins located close to the surface of the skin. There are two principal vessels in the superficial venous system:
Great saphenous vein (GSV): A large superficial leg vein running from the front of the anklebone, traveling alongside the inside of the leg and thigh until it empties into the deep vein in the groin called the femoral vein.
Small saphenous vein: A superficial leg vein that runs from outside of the foot and travels up the back of the calf where it empties into the deep vein in the crease of the knee (popliteal vein).
Deep veins: Larger veins located deep in the muscles of the leg.
Perforator veins: Veins that connect the superficial veins to the deep veins. The perforator veins are like the rungs on the ladder of the leg venous system.
* The ClosureFast™ Procedure is intended to be used in superficial veins only.
Veins in the leg that become swollen and have disease or damaged valves are known as varicose veins. Veins can become varicose when the vein valves that regulate the direction of blood flow become damaged or diseased, weaken and no longer function properly. Instead of blood moving toward the heart like it should, blood stays in place and pools in the vein of the leg.²
Often covering the legs, these damaged veins appear to be similar to varicose veins, only thinner. Often red or blue in color and appearing like thin spider webs or branches, these veins are closer to the skin surface and can spread; however, unlike varicose veins, spider veins are typically not raised above the skin’s surface. Spider veins can be treated with sclerotherapy or laser treatment. Though spider veins may be associated with varicose veins or CVI, the issue is seen as cosmetic and treatment is generally regarded as elective.²
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Healthy leg veins contain valves, or small delicate flaps of tissue that open and close to help regulate blood flow to the heart. These veins are designed to allow blood to flow against gravity from the legs back up toward the heart. The valves help control the flow of blood to make this happen. With age and other stresses on the body¹, these valves can weaken and lose the ability to regulate the direction of blood circulation.
Venous reflux is the term that describes what happens when the valves in the veins grow weak or damaged and lose the ability to regulate the direction of blood flow. When blood “leaks” down past a bad valve, it is called reflux. Reflux causes blood to pool in the leg veins as opposed to moving upward toward the heart.
If CVI is left untreated, legs can sometimes develop painful sores or wounds on the skin’s surface called ulcers. Ulcers may indicate a more severe and progressive state of the disease.¹ Normally ulcers appear near the ankles or lower leg and are brought on from the increased build-up of fluid and blood pressure from veins affected by CVI.¹
Duplex Ultrasound Test
This is a commonly used test to screen for varicose veins or CVI, which utilizes sound waves to measure the speed of blood flow through vessels. The ultrasound test also produces an image of vein structure, offering doctors a visual of veins, valve damage and any vein obstructions that may be causing CVI.
Continuous Wave Doppler
This is an older form of CVI detection, in which doctors use a hand-held device that generates ultrasound waves to measure the velocity of blood flow in the veins. This tool uses audible sound to listen to blood flow and detect vein valves that are not working properly.
This is an imaging test that uses x-rays to view the leg’s blood vessels. This test involves an injected dye called contrast, which makes the blood in your veins appear on an x-ray. A doctor studies images on the x-ray to detect vein obstructions that can develop into CVI.
This testing method typically uses air cuffs placed on the leg. While one cuff is inflated then deflated at set times, the second measures changes in the volume of blood flow in the leg as veins fill and empty.
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Sclerotherapy is a varicose and spider vein treatment done under local anesthesia in which a drug is injected into affected veins. The drug thickens the vessel walls, sealing them so that abnormal veins can then no longer fill with blood. After successful treatment, the diseased vein will be absorbed by the body and blood flow will be rerouted to other veins.
Vein Ligation and Stripping
This combination of procedures is typically performed under general anesthesia by a surgeon in an outpatient setting. First, the surgeon will perform the ligation, where the diseased vein is tied off. Then the surgeon will surgically remove, or strip, the diseased vein through two small incisions in the groin and calf.
Phlebectomy is a mini-surgical treatment to remove small varicose veins from the legs. Veins are removed through a series of small incisions in the leg and the procedure is performed under local anesthesia with minimal scarring.
Long, thin tubes extruded from medical grade materials called catheters are used in minimally-invasive endovenous ablation treatments for varicose veins. The process of inserting a catheter into the body is called catheterization.
“Within” or by means of a vein.
A treatment that involves the insertion of a thin, flexible tube called a catheter into the vein to seal it shut by heating the catheter tip or segment. After the vein is sealed off, the blood is re-routed to other veins back to the heart. The treated vein then dries up, shrinks and is absorbed by the body.
There are two types of available endovenous ablation treatments:
This minimally-invasive procedure uses radiofrequency energy in 20 second bursts to provide heat to contract the collagen in the vein walls, causing them to collapse and seal off. The ClosureFast™ procedure is a minimally-invasive treatment option that uses radiofrequency ablation to seal off the affected vein so blood gets re-routed to other veins.
This minimally-invasive procedure delivers laser energy to heat the blood, causing it to coagulate, which ultimately causes the diseased vein to seal off. Laser devices have frequencies that range from 810 to 1470 nanometers (nm).
Non-tumescent, Non-thermal, Non-sclerosant
This unique approach eliminates the risk of thermal nerve injury when treating the small saphenous vein, which is a risk sometimes associated with certain thermal-based procedures. The procedure is administered without the use of tumescent anesthesia, avoiding patient discomfort associated with multiple needle sticks. The VenaSeal™ procedure is the only non-tumescent (no anethesia required), non-thermal (without the use of Radiofrequency Ablation or Laser Ablation), non-sclerosant (without the use of Sclerotherapy) procedure that uses a proprietary medical adhesive delivered endovenously (“within” or by means of a vein) to close the vein.
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1. “Chronic Venous Insufficiency.” Vascular Web. Society for Vascular Surgery, Jan. 2011. Web.http://www.vascularweb.org/vascularhealth/Pages/chronic-venous-insuffici....
2. “Varicose Veins and Spider Veins.” Department of Health and Human Services, June 2010. Web.http://www.womenshealth.gov/publications/our-publications/fact-sheet/var....