Epidemiology and prevention of venous thromboembolism

What Is Chronic Venous Insufficiency?

The veins in your legs carry blood back to your heart. They have one-way valves that keep blood from flowing backward. If you have chronic venous insufficiency (CVI), the valves don't work the way they should and some of the blood may go back down into your legs. That causes blood to pool or collect in the veins.

CVI can affect all the types of veins in your legs. This includes:

Deep veins. They are large veins that are deep in your body.

Superficial veins. They are close to your skin's surface. You can often see superficial veins.

Perforating veins. These veins connect deep and superficial veins.

Over time, CVI can cause pain, swelling, and skin changes in your legs. It may also lead to open sores called ulcers on your legs.

How common is chronic venous insufficiency?

About 150,000 people are diagnosed with CVI each year. Research shows CVI affects about 1 in 20 adults. Your risk for CVI goes up as you age.

Chronic venous insufficiency can be caused by sitting too much. (Photo Credit: iStock/Getty Images)

Chronic venous insufficiency vs. Post-thrombotic syndrome

CVI and post-thrombotic syndrome both refer to damaged leg veins. But post-thrombotic syndrome is a specific type of CVI. It's caused by deep vein thrombosis (DVT), which is a blood clot that develops in a deep vein. Even after the clot is gone, it can leave behind scar tissue that damages your vein.

A blood clot in a deep vein in your leg can damage a valve. If you don't exercise, that can cause CVI, too. So can sitting or standing for long stretches of time. That raises pressure in your veins and may weaken the valves.

Causes for valve damage can be:

Congenital. This means that you're born with problems in your leg veins.

Primary. Your leg veins change, and they don't work the way they should.

Secondary. Medical conditions, such as DVT, damage your leg veins.

Women are more likely than men to get CVI and have vein problems. In fact, those assigned female at birth (AFAB) are nearly twice as likely to have varicose veins (twisted, enlarged veins close to the surface of the skin). Some research suggests that the higher rates of CVI in people AFAB may be due to changes that happen in pregnancy. 

Your chances also might be higher if you are:

Obese

Over age 50

Pregnant or have been pregnant more than once

From a family with a history of CVI

Someone with history of blood clots

A smoker

You may notice these in your legs:

Swelling or heaviness, especially in the lower leg and ankle

A dull ache or cramping in the legs

Tingling or burning in your legs

Pain that gets worse when you stand or gets better when you put your legs up

Itchiness

Varicose veins

Chronic venous insufficiency skin changes, which may include skin that is irritated, cracked, discolored, flaky, weepy, or looks like leather 

Without treatment, the pressure and swelling will burst the tiny blood vessels in your legs called capillaries. That could turn your skin reddish-brown, especially near the ankles. This can lead to swelling and ulcers. These ulcers are tough to heal. They are also more likely to get infected, which can cause more problems.

If you have any of the symptoms of CVI, talk to your doctor. The sooner you treat it, the less likely you'll get ulcers.

To classify venous disorders, doctors use these stages:

Stage 0. You have no signs that can be seen or felt. But you may have some symptoms, such as achy or tired legs.

Stage 1. You have visible blood vessels, including spider veins. 

Stage 2. You have varicose veins that are at least 3 millimeters wide.

Stage 3. You have swelling but no skin changes.

Stage 4. You notice changes to your skin's color or texture.

Stage 5. You have a healed ulcer.

Stage 6. You have an active ulcer. 

Early stages of chronic venous insufficiency 

To be diagnosed with CVI, you must be at stage 3 or higher. That means you can have varicose or spider veins, but not full-blown CVI. In the beginning stages of a venous disorder, you might also notice tired or achy legs. These early signs could get worse over time, so it's important to tell your doctor about them.

Your doctor will take your medical history. They then will check the blood flow in your legs with a test called a vascular or duplex ultrasound. Your doctor will place a small device on your skin over the vein. Using sound waves, they can see the blood vessel and check how quickly and in what direction the blood flows.

Sometimes, you may need X-rays or specific scans to check for other causes of your leg swelling. Specific imaging tests such as MRA or CT can show blockages or narrowed veins.

Venous insufficiency test 

Doctors may rely on the results of several tests, including a physical exam, duplex ultrasound, and other scans, to diagnose venous insufficiency.  

The main goal is to stop swelling and prevent leg ulcers. Your doctor may suggest a combination of treatments based on your age, symptoms, and other things. Some options to help manage CVI include:

Chronic venous insufficiency medications

Your doctor may prescribe an antibiotic to treat infections or leg ulcers. Sometimes, they'll give you medicine to help prevent blood clots. These are called blood thinners.

You may also receive a medicated wrap. It consists of compression materials and a zinc oxide ointment. 

Chronic venous insufficiency medical procedures 

If your CVI is further along, you may need a nonsurgical treatment.

Sclerotherapy. Your doctor will inject a solution into the problem vein. It scars the vein, forcing blood to flow through healthier veins. Over time, your body absorbs the scarred vein.

Endovenous thermal ablation. This newer method uses high-frequency radio waves or a laser to heat and close the problem vein.

Surgery for chronic venous insufficiency

Fewer than 1 in 10 people need surgery for CVI.

Here are your options:

Ligation. The vein is cut and tied off so blood can't flow through. Your doctor may also remove a vein that is very damaged. You usually will go home on the same day.

Microincision/ambulatory phlebectomy. This technique uses much smaller cuts, punctures, and small hooks to remove damaged veins. 

Vein repair. Your doctor fixes the vein or the valves. This can be done through an open cut on your leg or through a smaller opening by using a long, hollow catheter or tube.

Vein transplant. Your doctor replaces the problem vein with a healthy one from somewhere else in your body.

Vein bypass. This is done on veins in the upper thigh and only in the most severe cases. Your doctor takes part of a healthy vein from another part of your body. They'll use that to reroute blood around the affected vein. You'll usually stay in the hospital for 2-5 days.

You can help blood flow better in your leg veins. Steps include:

Compression stockings. These elastic socks put pressure on your legs to help blood move. They come in different tightnesses, lengths, and styles. Your doctor can suggest which might work best for you.

Movement. Try not to sit or stand for a long time. If you have to sit for a while, stretch or wiggle your legs, feet, and ankles often to help your blood flow. If you stand a lot, take breaks to sit and put your feet up. This helps lower pressure in your leg veins.

Exercise. Working out helps pump your blood, too. Walking is a good, simple way to make your legs stronger and boost blood flow.

Diet for venous insufficiency

Doctors typically suggest a heart-healthy diet for venous insufficiency. This includes lots of vegetables, fruits, and whole grains. 

Also, you should limit your salt intake. Salt can cause too much fluid to build up in your legs, which may put pressure on your veins and worsen CVI. 

You may not be able to prevent CVI completely, but you can lower your risk with these lifestyle changes:

Avoid smoking or other tobacco use.

Don't wear tight clothing.

Eat a healthy, low-salt diet.

Exercise regularly.

Maintain a healthy weight.

Don't stand or sit for too long at a time.

CVI can be managed if you're treated in the early stages. The condition usually isn't life-threatening. But it can get worse over time and affect your quality of life.  

CVI is a venous disease that happens when veins in your legs are damaged. Though the damage can't be reversed, treatments and lifestyle changes can keep your symptoms at bay. It's important to see your doctor if you have any signs of CVI. 

How serious is chronic venous insufficiency?

CVI is generally not considered a serious health threat. But it can be painful and affect your quality of life. 

What are the signs of CVI?

Some common signs of CVI are:

Achy, heavy, or crampy legs

Pain that gets worse when you stand or better when your feet are raised

Itching and tingling in the legs

Swelling of the legs

Irritated, cracked, flaky, or thickened skin

Varicose veins

Wounds that are slow to heal

Is CVI a developmental disability?

CVI is not a developmental disability. Another condition with the same abbreviation, called cortical visual impairment (CVI), is a leading cause of vision problems in children and can come with developmental disabilities. 

Comparing Phlebothrombosis And Thrombophlebitis

Phlebothrombosis and thrombophlebitis are both conditions related to blood clots in veins. However, they have distinct characteristics and implications.

Phlebothrombosis refers to a blood clot in a deep vein without significant inflammation. It is also known as deep vein thrombosis (DVT). DVT poses a high risk for pulmonary embolism, which is a blood clot in the lungs.

Thrombophlebitis, on the other hand, involves both a clot and inflammation in a superficial vein. It is typically less severe, but still requires medical attention to manage symptoms and prevent complications.

This article looks at the differences and similarities between the two conditions.

Treatments for phlebothrombosis (DVT) include:

Anticoagulants: Also known as blood thinners, these medications are the primary treatment for DVT. They prevent new clots from forming and existing clots from getting bigger. Examples include warfarin, heparin, and newer oral anticoagulants such as rivaroxaban or apixaban.

Compression stockings: Wearing graduated compression stockings can help reduce the swelling associated with DVT.

Elevation and physical activity: Elevating the affected leg and engaging in regular physical activity under the direction of a healthcare professional can help improve blood flow and reduce symptoms.

Thrombolytics: In severe cases, doctors might use thrombolytic therapy to dissolve the clot. This is especially true when there is a risk of pulmonary embolism.

Surgical intervention: In rare cases, surgical procedures may be necessary. These can include procedures such as thrombectomy, or clot removal.

Treatments for thrombophlebitis (SVT) include:

Warm compresses and elevation: Applying warm compresses to the affected area and elevating the limb can reduce discomfort and swelling.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen can help reduce pain and inflammation.

Topical treatments: Topical heparin or similar medications can reduce symptoms.

Compression stockings: These can also be beneficial in managing symptoms of SVT.

Anticoagulants: In some cases, doctors may recommend short-term use of anticoagulant medications. This is especially true if the patient is at risk for more serious complications.

With prompt diagnosis and proper treatment, many people with DVT recover successfully. The key is to manage the condition to prevent complications.

The most serious risk associated with DVT is pulmonary embolism (PE), which can be life threatening. However, the risk significantly decreases with effective anticoagulant therapy.

Some people may develop post-thrombotic syndrome. This is a condition characterized by chronic pain and swelling. In severe cases, it can cause skin ulcers in the affected limb. This is more likely if the DVT was extensive or if there were delays in treatment.

The prognosis for superficial thrombophlebitis is usually quite good, especially with early treatment. Most cases resolve without serious complications.

With appropriate treatment, symptoms typically improve within a few weeks. This can include NSAIDs, compression therapy, and sometimes topical or systemic anticoagulation.

In some cases, SVT can recur or progress to DVT. Close monitoring and following preventive measures can help reduce this risk.

Thrombophlebitis may also be associated with an underlying condition, such as a clotting disorder or cancer. In these cases, managing the underlying condition is crucial for the overall prognosis.

Read on for answers to some commonly asked questions about thrombophlebitis and phlebothrombosis.

Is thrombophlebitis the same as a blood clot?

In thrombophlebitis, a blood clot forms in a vein, and the vein's wall becomes inflamed. This distinguishes it from a clot that might occur elsewhere in the body without causing significant vein inflammation.

What is the other name for thrombophlebitis?

Another name for thrombophlebitis is superficial vein thrombosis (SVT). It describes a condition where there is both inflammation of a superficial vein (phlebitis) and the presence of a thrombus (blood clot) within that vein.

The term "superficial" indicates that the affected veins are near the surface of the body. Conversely, deep vein thrombosis (DVT) occurs in the deeper veins.

What are the 3 types of phlebitis?

Phlebitis refers to the inflammation of a vein. It can be classified into three main types based on the location and cause of the inflammation. These are superficial, deep vein, and migratory thrombophlebitis.

Phlebothrombosis and thrombophlebitis are conditions characterized by the formation of blood clots in the veins.

Phlebothrombosis occurs in the deep veins. Without treatment, it can lead to serious complications, such as pulmonary embolism. Thrombophlebitis affects superficial veins and is generally less severe.

One Man's Journey With Chronic Eczema

Eric Gray's journey with eczema—a two-year saga—started innocently enough. On vacation in Florida with his family, he noticed a faint red spot on his hip. While the patch was itchy and slightly inflamed, he didn't think much of it. But the irritation didn't go away.

Coincidentally, his wife was dealing with shingles at the time on the exact same spot on her body, so Gray figured he might have the same viral infection. He visited his doctor and was prescribed medication for shingles. But as the itchy rash began spreading to other areas of his body—his lower legs, back, arms, and hands—it became clear that he didn't have the proper diagnosis.

And ruling out shingles didn't get him any closer to an answer. One dermatologist thought the rashes were warts and wanted to burn them off. Another thought he might have a hazelnut allergy. "I avoided hazelnuts as directed, but I kept itching the whole time with no relief," he remembers. Finally, Gray was diagnosed with atopic dermatitis, the most common form of eczema and a chronic condition that causes the skin to become inflamed, dry, and itchy.

Finding Treatment

Putting a name to Gray's condition was only half the battle; figuring out how to treat his eczema proved to be just as frustrating as diagnosing it had been. "I tried so many creams," Gray says. "I still have a container full of probably 10 different tubes. Some of them helped temporarily, but none provided the relief I was looking for. I couldn't sleep at night due to the constant itching, and it started to bother me at work. It was becoming very challenging."

His symptoms bothered him during his everyday life, from his career as an electrician to hobbies like golf and going to the gym. They became so burdensome that he had to sleep with petroleum jelly and rubber gloves on his hands to keep himself from scratching throughout the night. He didn't leave the house without skin cream or lotion to apply hourly to his inflamed areas. "I was itching so much," Gray says. "My right hand, down into my thumb and first two fingers, was cracked and itching constantly."

Sponsored by Incyte

Finding Relief

After months of trial and error, Gray's doctor asked if he'd be willing to try a new prescription topical medication called OPZELURA® (ruxolitinib) cream 1.5%, a non-steroidal cream that is FDA-approved for the short-term and non-continuous treatment of mild to moderate eczema in certain people aged 12 and over whose disease is not well controlled with topical prescription therapies or when those therapies are not recommended. The use of OPZELURA along with therapeutic biologics, other JAK inhibitors, or strong immunosuppressants such as azathioprine or cyclosporine is not recommended.

OPZELURA is not for everyone. See below for IMPORTANT SAFETY INFORMATION including boxed Warning for Serious Infections, Increased Risk of Death, Lymphoma and other Cancers, Major Cardiovascular Events and Blood Clots.

After using OPZELURA, Gray found that within a few days the itching was gone, and in a few weeks his skin began to clear. "I couldn't believe it," Gray says. (Please note, individual results may vary.)

Gray has been using OPZELURA twice daily as needed for over a year now. Maintenance treatment with the medicine is straightforward, requiring only a thin layer of the medication twice a day*. Looking back on his journey, Gray emphasizes that the key to overcoming his struggles with eczema was staying diligent and collaborating with his dermatologist to find a treatment option that was best for him.

"I kept trying things and finally found something that worked. It's really helped to relieve my symptoms," he says. "I encourage others experiencing skin issues not to give up. Do your research and ask your doctor about OPZELURA. Finding the right treatment for yourself makes all the difference."

Eric is a paid participant in Inycte's "Moments of Clarity" program, highlighting the authentic stories of people living with mild to moderate eczema and their journey to finding relief from their symptoms. To hear more from Eric and others who found relief with OPZELURA, visit MyMomentsofClarity.Com.

*Stop using when signs and symptoms (e.G., itch, rash, and redness) of atopic dermatitis resolve. If signs and symptoms do not improve within eight weeks, patients should be re-examined by their healthcare provider.

IMPORTANT SAFETY INFORMATION

OPZELURA is for use on the skin only. Do not use OPZELURA in your eyes, mouth, or vagina.

OPZELURA may cause serious side effects, including:

Serious Infections: OPZELURA contains ruxolitinib. Ruxolitinib belongs to a class of medicines called Janus kinase (JAK) inhibitors. JAK inhibitors are medicines that affect your immune system. JAK inhibitors can lower the ability of your immune system to fight infections. Some people have had serious infections while taking JAK inhibitors by mouth, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have been hospitalized or died from these infections. Some people have had serious infections of their lungs while taking OPZELURA. Your healthcare provider should watch you closely for signs and symptoms of TB during treatment with OPZELURA.

OPZELURA should not be used in people with an active, serious infection, including localized infections. You should not start using OPZELURA if you have any kind of infection unless your healthcare provider tells you it is okay. You may be at a higher risk of developing shingles (herpes zoster) while using OPZELURA.

Increased risk of death due to any reason (all causes): Increased risk of death has happened in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking a medicine in the class of medicines called JAK inhibitors by mouth.

Cancer and immune system problems: OPZELURA may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers have happened in people taking a medicine in the class of medicines called JAK inhibitors by mouth. People taking JAK inhibitors by mouth have a higher risk of certain cancers including lymphoma and lung cancer, especially if they are a current or past smoker. Some people have had skin cancers while using OPZELURA. Your healthcare provider will regularly check your skin during your treatment with OPZELURA. Limit the amount of time you spend in the sunlight. Wear protective clothing when you are in the sun and use a broad-spectrum sunscreen.

Increased risk of major cardiovascular events: Increased risk of major cardiovascular events such as heart attack, stroke, or death have happened in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and taking a medicine in the class of medicines called JAK inhibitors by mouth, especially in current or past smokers.

Blood clots: Blood clots in the veins of your legs (deep vein thrombosis, DVT) or lungs (pulmonary embolism, PE) can happen in some people taking OPZELURA. This may be life-threatening. Blood clots in the vein of the legs (deep vein thrombosis, DVT) and lungs (pulmonary embolism, PE) have happened more often in people who are 50 years of age and older and with at least 1 heart disease (cardiovascular) risk factor taking a medicine in the class of medicines called JAK inhibitors by mouth.

Low blood cell counts: OPZELURA may cause low platelet counts (thrombocytopenia), low red blood cell counts (anemia), and low white blood cell counts (neutropenia). If needed, your healthcare provider will do a blood test to check your blood cell counts during your treatment with OPZELURA and may stop your treatment if signs or symptoms of low blood cell counts happen.

Cholesterol increases: Cholesterol increase has happened in people when ruxolitinib is taken by mouth. Tell your healthcare provider if you have high cholesterol or triglycerides.

Before starting OPZELURA, tell your healthcare provider if you:

have an infection, are being treated for one, or have had an infection that does not go away or keeps coming back

have diabetes, chronic lung disease, HIV, or a weak immune system

have TB or have been in close contact with someone with TB

have had shingles (herpes zoster)

have or have had hepatitis B or C

live, have lived in, or have traveled to certain parts of the country (such as the Ohio and Mississippi River valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections. These infections may happen or become more severe if you use OPZELURA. Ask your healthcare provider if you do not know if you have lived in an area where these infections are common.

think you have an infection or have symptoms of an infection such as: fever, sweating, or chills, muscle aches, cough or shortness of breath, blood in your phlegm, weight loss, warm, red, or painful skin or sores on your body, diarrhea or stomach pain, burning when you urinate or urinating more often than usual, feeling very tired

have ever had any type of cancer, or are a current or past smoker

have had a heart attack, other heart problems, or a stroke

have had blood clots in the veins of your legs or lungs in the past

have high cholesterol or triglycerides

have or have had low white or red blood cell counts

are pregnant or plan to become pregnant. It is not known if OPZELURA will harm your unborn baby. There is a pregnancy exposure registry for individuals who use OPZELURA during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. If you become exposed to OPZELURA during pregnancy, you and your healthcare provider should report exposure to Incyte Corporation at 1-855-463-3463.

are breastfeeding or plan to breastfeed. It is not known if OPZELURA passes into your breast milk. Do not breastfeed during treatment with OPZELURA and for about 4 weeks after the last dose.

After starting OPZELURA:

Call your healthcare provider right away if you have any symptoms of an infection. OPZELURA can make you more likely to get infections or make worse any infections that you have.

Get emergency help right away if you have any symptoms of a heart attack or stroke while using OPZELURA, including:

discomfort in the center of your chest that lasts for more than a few minutes, or that goes away and comes back

severe tightness, pain, pressure, or heaviness in your chest, throat, neck, or jaw

pain or discomfort in your arms, back, neck, jaw, or stomach

shortness of breath with or without chest discomfort

breaking out in a cold sweat

nausea or vomiting

feeling lightheaded

weakness in one part or on one side of your body

slurred speech

Tell your healthcare provider right away if you have any signs and symptoms of blood clots during treatment with OPZELURA, including: swelling, pain, or tenderness in one or both legs, sudden, unexplained chest or upper back pain, or shortness of breath or difficulty breathing.

Tell your healthcare provider right away if you develop or have worsening of any symptoms of low blood cell counts, such as: unusual bleeding, bruising, tiredness, shortness of breath, or fever.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

The most common side effects of OPZELURA in people treated for atopic dermatitis include: common cold (nasopharyngitis), diarrhea, bronchitis, ear infection, increase in a type of white blood cell (eosinophil) count, hives, inflamed hair pores (folliculitis), swelling of the tonsils (tonsillitis), and runny nose (rhinorrhea).

The most common side effects of OPZELURA in people treated for nonsegmental vitiligo include: acne at the application site, itching at the application site, common cold (nasopharyngitis), headache, urinary tract infection, redness at the application site, and fever.

These are not all of the possible side effects of OPZELURA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Incyte Corporation at 1-855-463-3463.

INDICATIONS AND USAGE

OPZELURA is a prescription medicine used on the skin (topical) for:

short-term and non-continuous chronic treatment of mild to moderate eczema (atopic dermatitis) in non-immunocompromised adults and children 12 years of age and older whose disease is not well controlled with topical prescription therapies or when those therapies are not recommended

the treatment of a type of vitiligo called nonsegmental vitiligo in adults and children 12 years of age and older

The use of OPZELURA along with therapeutic biologics, other JAK inhibitors, or strong immunosuppressants such as azathioprine or cyclosporine is not recommended.

It is not known if OPZELURA is safe and effective in children less than 12 years of age with atopic dermatitis or nonsegmental vitiligo.

Please see the Full Prescribing Information, including Boxed Warning, and Medication Guide for OPZELURA.

OPZELURA, Incyte, and the Incyte logo are registered trademarks of Incyte.

© 2024, Incyte Corporation. MAT-OPZ-01931 01/24

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Epidemiology and prevention of venous thromboembolism