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Chronic Venous InsufficiencyAka: Venous Insufficiency, Venous Stasis

Risk Factors
Pathophysiology
1. Normal Venous valves prevent backflow
  1. Distal to Proximal vein backflow
  2. Superficial to Deep vein backflow
2. Incompetent valves allow backflow when legs relax
  1. Results in distal venous Hypertension
  2. Primary etiology for chronic venous insufficiency
Symptoms and Signs
1. Initial Changes
  1. Varicose veins
  2. Tan or reddish brown skin color changes
  3. Weeping and excoriated skin
  4. Pedal edema
2. Later Changes
  1. Lipodermatosclerosis
    1. Induration at medial ankle to mid-leg
3. Advanced Changes
  1. Brawny edema above and below fibrotic area
  2. Ulcerations
Complications
1. Venous Stasis Ulcers
  1. More common in older women
  2. Chronic and often recurrent
2. Postphlebitic Syndrome
  1. Chronic Leg Edema
  2. Deep Venous Thrombosis
  3. Pigmentation
  4. Ulceration
Diagnosis
1. Duplex Ultrasonound (B-Mode and Directional Pulse)
  1. Can accurately assess venous reflux
  2. Can also be used to assess Arterial Insufficiency
    1. With Ultrasound ankle/brachial index (See below)
2. Descending Venography
  1. Not as accurate as Duplex scanning
Management
1. Confirm No Arterial Insufficiency
  1. Assess before managing Venous Insufficiency
  2. Ankle-Brachial Index
    1. Blood Pressure measurement
    2. Doppler ultraound measurement
2. Elevate Legs above Heart 30 minutes each tid-qid
3. Compression stockings (Jobst Stockings)
4. Intermittent Pneumatic Compression Pumps
  1. Indications
    1. Obesity
    2. Moderate to Severe edema
  2. Contraindications
    1. Uncompensated Congestive Heart Failure
5. Diuretics
  1. Short term use
  2. Indications: Severe edema
6. See Venous Stasis Ulcer Management
Reference
1. Alguire (1997) J Gen Intern Med 12:374

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.