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Venous Insufficiency

Aka: Venous Insufficiency, Venous Stasis, Chronic Venous Insufficiency, Lipodermatosclerosis
  1. See Also
    1. Varicose Vein
  2. Risk Factors
    1. Obesity
    2. Congestive Heart Failure
    3. Diabetes Mellitus
  3. 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
  4. 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
  5. Complications
    1. Venous Stasis Ulcers
      1. More common in older women
      2. Chronic and often recurrent
    2. Postphlebitic Syndrome
      1. Chronic Leg Edema
      2. Lipodermatosclerosis (see signs above)
      3. Deep Venous Thrombosis
      4. Superficial Thrombophlebitis
      5. Pigmentation
      6. Ulceration
    3. Overlying Skin Changes
      1. Eczema
      2. Cellulitis and other secondary infection
  6. 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
  7. 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
  8. Reference
    1. Alguire (1997) J Gen Intern Med 12:374-83

Chronic venous insufficiency (C1306557)

Concepts Disease or Syndrome (T047)
ICD10 I87.2
SnomedCT 195516009, 20696009
English Chronic venous insufficiency, NOS, Chronic venous insuffic.NOS, Chronic venous insufficiency NOS, Venous insufficiency (chronic) (peripheral), chronic peripheral venous insufficiency, chronic peripheral venous insufficiency (diagnosis), Chronic venous insufficiency NOS (disorder), Venous insufficiency (chronic)(peripheral), chronic insufficiency venou, chronic venous insufficiency, Chronic venous insufficiency
Dutch chronische veneuze insufficiëntie, Veneuze insufficiëntie (chronisch)(perifeer)
French Insuffisance veineuse chronique
German chronisch venoese Insuffizienz, Venoese Insuffizienz (chronisch) (peripher)
Italian Insufficienza venosa cronica
Portuguese Insuficiência venosa crónica
Spanish Insuficiencia venosa crónica, insuficiencia venosa crónica, SAI (trastorno), insuficiencia venosa crónica, SAI, insuficiencia venosa crónica
Japanese 慢性静脈機能不全, ﾏﾝｾｲｼﾞｮｳﾐｬｸｷﾉｳﾌｾﾞﾝ
Czech Chronická venózní nedostatečnost
Korean 정맥기능부전(만성)(말초성)
Hungarian Chronikus venás elégtelenség
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Venous Insufficiency (C0042485)

Definition (MSH) Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
Concepts Disease or Syndrome (T047)
MSH D014689
ICD9 459.81
SnomedCT 20696009
English Insufficiencies, Venous, Venous Insufficiencies, Insufficiency, Venous, VENOUS INSUFFICIENCY, Venous insufficiency, Peripheral venous insufficiency, NOS, Venous (peripheral) insufficiency, unspecified, venous insufficiency (diagnosis), venous insufficiency, VENOUS INSUFFICIENCY CHRONIC, Venous insufficiency NOS, Venous Insufficiency [Disease/Finding], peripheral venous insufficiency, Insufficiency;venous, insufficiency venous, Venous Insufficiency, Peripheral venous insufficiency (disorder), Peripheral venous insufficiency, insufficiency; venous, venous; insufficiency, Peripheral venous insufficiency, unspecified, Venous insufficiency, unspecified
Dutch veneuze (perifere) insufficiëntie, niet-gespecificeerd, insufficiëntie; veneus, veneus; insufficiëntie, veneuze insufficiëntie, Insufficiëntie, veneuze, Veneuze insufficiëntie
French Insuffisance veineuse (périphérique), non précisée, Insuffisance veineuse
German Veneninsuffizienz (peripher), unspezifisch, Veneninsuffizienz
Italian Insufficienza (periferica) venosa non specificata, Insufficienza venosa
Portuguese Insuficiência venosa (periférica) NE, Insuficiência venal, Insuficiência Venosa
Spanish Insuficiencia venosa (periférica) no especificada, insuficiencia venosa periférica (trastorno), insuficiencia venosa periférica, Insuficiencia venosa, Insuficiencia Venosa
Japanese 静脈（末梢）不全、詳細不明, 静脈不全, ｼﾞｮｳﾐｬｸﾏｯｼｮｳﾌｾﾞﾝｼｮｳｻｲﾌﾒｲ, ｼﾞｮｳﾐｬｸﾌｾﾞﾝ
Swedish Venös insufficiens
Czech venózní insuficience, žilní nedostatečnost, Žilní insuficience, Žilní (periferní) nedostatečnost, blíže neurčená
Finnish Laskimoiden vajaatoiminta
Russian VENOZNAIA NEDOSTATOCHNOST', ВЕНОЗНАЯ НЕДОСТАТОЧНОСТЬ
Croatian VENSKA INSUFICIJENCIJA
Polish Niewydolność żylna
Hungarian Venás (peripheriás) elégtelenség, nem meghatározott, Venás elégtelenség
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lipodermatosclerosis (C0406500)

Definition (SNOMEDCT) A decrease in lower leg circumference due to recurrent ulceration and fat necrosis causing loss of subcutaneous tissue in a patient with venous stasis disease
Concepts Disease or Syndrome (T047)
MSH C537026
SnomedCT 201301003, 201306008, 95335006, 410016009
English Lipodermatosclerosis, NOS, Post-phlebitic liposclerosis, Acute lipodermatosclerosis, Lipodermatosclerosis, lipodermatosclerosis, Lipodermatosclerosis (disorder)
Dutch lipodermatosclerose
French Lipodermatosclérose
German Lipodermatosklerose
Italian Lipodermatosclerosi
Portuguese Lipodermatosclerose
Spanish Lipodermatoesclerosis, lipodermatoesclerosis (trastorno), Lipodermatosclerosis, lipodermatosclerosis (trastorno), lipodermatosclerosis, lipodermatoesclerosis
Japanese 脂肪皮膚硬化症, ｼﾎﾞｳﾋﾌｺｳｶｼｮｳ
Czech Lipodermatoskleróza
Hungarian Lipodermatosclerosis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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