Chronic Venous Insufficiency

Related Terms:

Edema, lymphedema, post phlebitic syndrome, postthrombitic syndrome, CVI, venous pooling, phlebo-lymphedema, lipodermatosis, ilio femoral disease, venous disease, diabetes millitus

Discussion:

Chronic venous insufficiency is a condition of poor blood return from the lower extremities (feet, and legs) to the heart.

Risk Factors, Etiology:

Age, family history of deep venous thrombosis, sedentary lifestyle, obesity, smoking, deep vein thrombosis, congestive heart failure, diabetes mellitus, occupations that require long term standing.

Symptoms:

Chronic foot or leg swelling in the affected limb, varicose veins, no healing leg ulcers, affected limb may experience pain pressure, itching, dull ache, or heaviness in the affected limb. Skin changes which may include lipodermatosis, fat necrosis, fibrosis of the skin and subcutaneous layers. The skin color may become reddish or brown due to the accumulation of red blood cells.

Complications:

Edema of the affected leg or foot, ulcerations, deep venous thrombosis, pigmentation and pain.

Diagnosis:

Radiological test may be prescribed to verify chronic venous insufficiency. These test may include doppler bi-directional-flow studies, photoplethysmography , outflow plethysmography tests. Other test may include venograms, and duplex ultrasounds.

Treatments:

Treatments will focus on two facets. First the complications of CVI must be treated. This may include decongestive therapy for the edema or swelling. This may include not only decongestive massage and hosiery but compression pump therapy as well. Secondly, treatments will focus on the original cause of the CVI.

These treatments are broken into two categories. First are the non-surgical treatments. These will include leg elevation, compression stockings, use of Unna boots for chronic ulcerations, and injection sclerotherapy.

Surgical intervention will commonly be prescribed for patients who have CVI resulting from the congenital anomaly of weakened or non existent vein valves. In this procedure, competent veins will be graft in replacement of defective veins.

For iliofemoral disease , the operation of choice is a saphenous vein cross over graft. In the procedure, the contralateral vein is mobilized and divided at its distal end. It is then tunneled suprapubilcally and anastomosed to the femoral vein on the deceased side. The result is the diversion of venous blood through the graft and into the intact contralateral venous system. (1)

Other treatments will focus on skin care to relieve itching, and ulcerations. Antibiotic therapy may be required for any infections resulting from the ulcerations.

Long term treatment will naturally focus on the underlying cause of the chronic venous insufficiency.

Diuretics may also be prescribed for a short term therapy.

(c) Pat O'Connor - Lymphedema People

Chronic Venous Insufficiency

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For Further Information:

Chronic Venous Insufficiency (1)

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Chronic Venous Insufficiency

Family Practice Notebook

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Chronic Venous Insufficiency Clinical Resources