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

Comments