Venous Insufficiency

CHRONIC VENOUS INSUFFICIENCY: Effective venous return depends on 4 factors  Central pump Pressure gradient Abdominal increased pressure causes decrease gradient  Peripheral Venous Pump Calf muscle contraction  Hydrostatic Pressure On long flight, edema occurs due to sustained hydrostatic pressure  Type Primary CVI Secondary CVI  C.F Symptoms Pain, aching, throbbing, muscle cramps Signs (6 stages) Telangiencesia Protruding varicose vein Venous Stasis Ulcer Hyperpigmentation Lipodermatoclearosis Scar  Advanced form: Present in 6 %  . Calssification (CEAP) Clinical Classification Etiology Anatomy Physiology Classification of edema Venous Edema ankle to knee unilateral Lhyphadema Toes to groin unilateral Lipedema  Ankle to groin bilateral Ulcer Characteristics Venous Arterial Neuropathic Managemnet COnservative Graduated compression NOTE: TED HOSE ARE NOT USED (around 18 mmhg)  20-30 for mild venous stasis is typically needed  weight loss exercise  leg elevation  References: Chronic Venous Disease NEJM 2006 Chronic Venous Disease NEJM 2006 Chronic Venous Disease NEJM 2006 Chronic Venous Disease NEJM 2006 Chronic Venous Insufficiency and Varicose Veins NEJM 2009