Table Of Contents

Chronic Venous Insufficiency

Watch ▶Venous insufficiency and ulcers: Clinical sciences

General

• Normal flow is unidirectional from the superficial to the deep system through penetrating veins.
• Bidirectional blood flow in penetrating veins suggests CVI.

Pathophysiology

Risk Factors

• Female sex
• Family history of vascular disease (e.g., father with ischemic stroke at a young age)
• Pregnancy
• Obesity
• Prolonged standing (e.g., soldiers)

Clinical Features

• Symptoms
  • Leg heaviness
  • Pain
  • Cramping
• Physical Examination Findings
  • Varicose or dilated veins [A]
  • Nonpitting edema
  • Lower extremity discoloration
  • Stasis Dermatitis [B]

Complications

• Chronic venous stasis ulcers [C]

Diagnosis

• Clinical Diagnosis
  • Based on symptoms and physical examination.
• Duplex Ultrasonography
  • Used if the diagnosis is unclear.
  • Bidirectional blood flow in the great saphenous vein on duplex ultrasonography is diagnostic

Treatment

• Conservative Measures
  • Compression therapy with compression stockings
  • Frequent elevation of the legs
  • Physical therapy
  • Avoidance of heat and prolonged periods of standing or sitting with bent legs
• Refractory Cases
  • Venous ablation
  • Sclerotherapy
  • Other surgical interventions

Veins of the lower limb

[A]

[B]

• Another Stasis dermatitis picture

[C]

• UWT - Chronic venous insufficiency

Postthrombotic syndrome

Epidemiology

• Chronic venous insufficiency following acute DVT
• Most cases arise within 2 years of thrombus

<aside> 💡

• Approximately 50% of patients with acute DVT develop postthrombotic syndrome within 2 years due to venous hypertension distal to the site of previous thrombus.
• Investigate with venous Ultrasonography to rule out Recurrent DVT </aside>

Manifestations

• Leg edema, fatigue, pain, superficial venous dilation, venous stasis ulcers
• Often worse at the end of the day

Treatment

• Exercise
  • Ankle flexion
  • Walking
• Compression
  • Bandages & Stockings