Chronic venous insufficiency (CVI) occurs due to inadequate functioning of venous wall and/or valves in lower limb veins resulting in excessive pooling of blood.
The condition results from venous hypertension which in turn is usually caused by reflux in the superficial venous compartment. Less common causes include:
- deep venous compression
- post-thrombotic stenosis or occlusion
- deep venous reflux
- venous hypertension caused by vascular malformations, arteriovenous fistulae, and neuromuscular disorders (rare)
Findings are non-specific but most commonly are seen in the leg 5,6:
- solid undulating periosteal reaction, often symmetrical
- dystrophic soft tissue calcification
- varicose vein phleboliths
- soft tissue swelling from subcutaneous oedema
Venous Doppler ultrasound
The presence of reflux is determined by the direction of flow because any significant flow toward the feet is suggestive of reflux. The duration of reflux is known as the "reflux time" (replacing the commonly used "valve closure time"):
- a reflux time of > 0.5 (or 1.0 according to some publications) second has been used to suggest the diagnosis the presence of reflux, although a more refined definition with a variable “cutoff” based on location has been suggested
- the longer the duration of reflux or the greater the reflux time implies more severe disease
Venous duplex imaging may provide information about local valve function to construct an anatomic map of disease in terms of the systems and levels of involvement.
The presence and location of perforators are also documented. The patient should be able to stand for this procedure.
- 1. Khilnani NM, Min RJ. Imaging of venous insufficiency. Seminars in interventional radiology. 22 (3): 178-84. doi:10.1055/s-2005-921950 - Pubmed
- 2. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 111 (18): 2398-409. doi:10.1161/01.CIR.0000164199.72440.08 - Pubmed
- 3. Welch HJ, Young CM, Semegran AB, Iafrati MD, Mackey WC, O'Donnell TF. Duplex assessment of venous reflux and chronic venous insufficiency: The significance of deep venous reflux. Journal of Vascular Surgery. 24 (5): 755-762. doi:doi:10.1016/S0741-5214(96)70009-5 - Pubmed
- 4. Khilnani NM. Duplex ultrasound evaluation of patients with chronic venous disease of the lower extremities. AJR. American journal of roentgenology. 202 (3): 633-42. doi:10.2214/AJR.13.11465 - Pubmed
- 5. Miedinger D, Daikeler T. Images in clinical medicine. Chronic venous insufficiency and dystrophic subcutaneous calcification. The New England journal of medicine. 358 (9): e10. doi:10.1056/NEJMicm067082 - Pubmed
- 6. Rana RS, Wu JS, Eisenberg RL. Periosteal reaction. AJR. American journal of roentgenology. 193 (4): W259-72. doi:10.2214/AJR.09.3300 - Pubmed