Chronic venous insufficiency (CVI) results from failure of return of venous blood and increased capillary pressure; the resultant changes include edema, stasis dermatitis, hyperpigmentation, fibrosis of the skin and subcutaneous tissue (lipodermatosclerosis) of the leg, and ulceration.
Causes of Chronic Venous Insufficiency
The valves of the deep veins of the calf are damaged and incompetent at restricting backflow of blood. The communicating veins that connect deep and superficial calf veins are damaged, which also causes CVI in that blood flows from deep veins to superficial venous plexus. Fibrin is deposited in the extravascular space and undergoes organization, resulting in sclerosis and obliteration of lymphatics and microvasculature. Perivascular fibrosis results in diminished nutrition of the epidermis, which breaks down with ulcer formation.
This cycle repeats itself: initial event – aggravation of venous stasis and varicose vein dilatation – lipodermatosclerosis – new thrombosis – stasis dermatitis – ulceration.
Symptoms of Chronic Venous Insufficiency
CVI may cause feet and calves to become swollen, often accompanied by a dull ache made worse with prolonged standing. If CVI is allowed to progress, the skin tends to darken and ulcers may occur. CVI often causes varicose veins.
Other symptoms of chronic venous insufficiency include legs that ache, feel heavy, or feel tired, especially after long periods of standing; new varicose veins; leg skin that looks and feels leathery; and flaking and itching in the affected area of the legs.
Diagnosis
Usually made on history, clinical findings, and Doppler sonography.
Treatment
Prerequisite Compression dressings or stockings.
Atrophie Blanche Avoid trauma to area involved. Intralesional triamcinolone into painful lesions. Compression.
Varicose Veins Injection Sclerotherapy A sclerosing agent such as tetradecyl sulfate is injected into varicosities, followed by prolonged compression. Used mainly to treat minor branch varicosities not associated with saphenous incompetence and new branch vein varicosities developing after surgery. Recurrence is very common within 5 years.
Vascular Surgery Incompetent perforating veins are identified, ligated, and cut, followed by stripping long and/or short saphenous veins out of the main trunk. Residual perforating veins are the main cause of recurrences after surgery. In patients with combined arterial and CVI, bypass or angioplasty may prove beneficial.
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