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Chronic Venous Insufficiency (Management (first-line therapy includes…
Chronic Venous Insufficiency
Leg edema
, which can result from various
conditions that damage the leg veins and their valves
Risk factors
associated with the development of chronic venous insufficiency include
tobacco use, obesity, increasing age, family history of venous disease, history of venous thromboembolism and/or lower extremity trauma, and pregnancy
Postthrombotic syndrome
is the development of chronic venous insufficiency
following an acute deep venous thrombosis.
Symptoms
Edema
typically is
insidious
in onset. It
worsens with prolonged standing
and is
improved with elevating the legs and with walking
Leg discomfort
. Pain is often
gradual in onset
and is described as a
tired or heavy sensation in the legs
. Pain is also
worsened with prolonged standing and improves with walking and leg elevation
Other symptoms can include
pruritus, skin discoloration, and ulceration
Physical Exam
leg edema
skin
findings can include a
shiny, atrophic appearance to the skin
in addition to
varicose veins and telangiectasias
Venous ulcers
. In
severe cases
, there may be
ulceration overlying the medial malleolus
. The ulceration is often
surrounded by skin that is erythematous, scaled, and weeping
. The pain associated with venous ulcers is variable, ranging from mild to severe
Diagnostic
venous duplex ultrasonography can help to determine severity and document valvular incompetence.
Management
first-line therapy
includes
compression, leg elevation, and exercise
weight loss in obese patients, is also advisable
Diuretics
should generally be
AVOIDED
in these patients
Ablation therapy (chemical, surgical, and thermal)
should be reserved for patients who have
failed
to respond to
conservative therapy for at least 6 months
and who have
documented retrograde valvular flow on duplex ultrasonography (>0.5 seconds in duration)
Dry skin, itching, and eczematous changes are treated with
moisturizers