Chronic Venous Insufficiency

may result from DVT and/or valvular incompetence Pathophysiology

DVTCause valve leaflets become thickened and contracted so that they cannot prevent retrograde flow of the blood

The vein becomes rigid and thick walledSecondary incompetence develops in distal valves because high pressures distend the vein and separate the leaflets

Primary deep venous valvular dysfunction may also occur without previous thrombosis

Clinical Featureso Dull ache in the leg that worsens with prolnged standing and resolves with

leg elavationo Increased leg circumference, edema o (+) superficial varicose veinso (+) eryhtema, dermatitis and hyperpigmentation develop along the distal

aspect of the lego skin ulceration may occur near the medial and lateral malleolio cellulites may be a recurring problem

Managemento Patients should be advised to avoid prolonged standing or sittingo Frequent leg elevationo Graduated compression stockings shoud be worn during the dayo Ulcers

Wet to dry dressings Dilute topical antibiotic solutions Surgical interruption of incompetent communicating veins – for

recurrent ulceration and severe edema Surgical vavuloplasty Bypass of venous occlusions