venous insufficiency


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Related to venous insufficiency: arterial insufficiency

Venous Insufficiency

 

Definition

Venous insufficiency is described as abnormal blood flow through veins that can cause local damage, damage to affected legs, or death.

Description

Syndromes related to venous insufficiency are caused by valve incompetence. Venous insufficiency is a chronic (long term) condition. The number of new and existing cases is dependent on age and gender. Some patients may have a positive family history. Usually older persons and females are more commonly affected. Deep situated and superficial veins can be affected. Cancer obstructing veins in the pelvis area can cause superficial venous insufficiency. Deep venous insufficiency is commonly caused by thrombophlebitis, causing obstruction of valves that regulate blood flow in veins. Small veins that have been occluded by a thrombosis may re-canalize (opening up new channels to re-direct blood flow). These re-canalized veins are inadequate and cannot correct the impairment of flow. However, larger veins may still remain occluded. When a thrombosis occurs the valves that regulate venous blood flow become thickened and incompetent, rendering them incapable of regulating back flow of blood. This valvular incompetence will cause an increase in the presence within veins (venous hypertension). Venous hypertension is responsible for most of the symptoms associated with venous disease. Superficial veins can become dilated causing varicose veins (veins that bulge and seem tortuous). Leg ulcers can be severe and are responsible for 100,000 cases of disability in the United States alone.

Causes and symptoms

The symptoms of chronic venous insufficiency can be subjective and objective. Subjective symptoms include throbbing, cramping, burning sensations, and leg fatigue. Patients can also develop chronic leg ulcers that may not heal. Varicose veins in the legs can bleed (since veins are delicate structures with thin walls) and cause death. Patients often develop fluid retention (edema) in the affected limb. Skin changes can occur and affected areas can become thin, shiny, discolored (blue-purple), and atrophic. The skin usually becomes thick and tough.

Diagnosis

There are several techniques used to diagnose venous disease. Electrical impedance plethysmography (IPG) provides a functional evaluation for outflow obstruction ultrasound (a machine that transmits sound waves) studies can visualize the venous system in certain areas. Another technique called duplex scanning can measure velocity within a vein.

Treatment

Periodic elevation of legs and bed rest can help with leg swelling. Patients are advised to avoid prolonged periods of standing or sitting. Wearing compression stockings can also reduce swelling of the leg. Mild skin infections can be treated with compresses, steroids, and, if infection is present, with antibiotics. Ulcerations can be treated with compresses, possible surgery, special ointments, and a semi-rigid boot that helps improve blood flow. Varicose veins can be treated with elastic stockings. About 15-20% of patients require surgery, but only after careful evaluation and specialized testing confirms a beneficial value.

Prognosis

The prognosis is variable and depends on the progression of disease, extent of damage, and the presence of other diseases, which may affect the cardiovascular system.

Prevention

Persons who have a strong family history, evidence of disease, and/or those who stand on their legs many hours daily should discuss the option of elastic stocking with their primary clinician.

Resources

Books

Goroll, Alan H., et al. Primary Care Medicine. 4th ed. Lippincott, Williams & Wilkins, 2000.
Townsend, Courtney M. Sabiston Textbook of Surgery. 16th ed. W. B. Saunders Company, 2001.

Key terms

Atrophic — A wasting of cells and tissues.
Thrombophlebitis — Venous inflammation with formation of a thrombus.
Thrombus — A clot in the cardiovascular system (the system that circulates blood throughout the body).

insufficiency

 [in″sŭ-fish´en-se]
inability to perform properly an allotted function; called also incompetence.
adrenal insufficiency abnormally diminished activity of the adrenal gland; called also hypoadrenalism.
adrenocortical insufficiency abnormally diminished secretion of corticosteroids by the adrenal cortex; see also addison's disease. Called also hypoadrenocorticism and hypocorticism.
aortic insufficiency inadequate closure of the aortic valve, permitting aortic regurgitation.
coronary insufficiency decreased supply of blood to the myocardium resulting from constriction or obstruction of the coronary arteries, but not accompanied by necrosis of the myocardial cells. Called also myocardial ischemia.
ileocecal insufficiency inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.
mitral insufficiency inadequate closure of the mitral valve, permitting mitral regurgitation.
placental insufficiency dysfunction of the placenta, with reduction in the area of exchange of nutrients; it often leads to fetal growth retardation.
pulmonary valve insufficiency inadequate closure of the pulmonary valve, permitting pulmonic regurgitation.
respiratory insufficiency see respiratory insufficiency.
thyroid insufficiency hypothyroidism.
tricuspid insufficiency incomplete closure of the tricuspid valve, resulting in tricuspid regurgitation.
valvular insufficiency failure of a cardiac valve to close perfectly, causing valvular regurgitation; see also aortic, mitral, pulmonary, and tricuspid insufficiency.
velopharyngeal insufficiency inadequate velopharyngeal closure, due to a condition such as cleft palate or muscular dysfunction, resulting in defective speech.
venous insufficiency inadequacy of the venous valves and impairment of venous return from the lower limbs (venous stasis), often with edema and sometimes with stasis ulcers at the ankle.

ve·nous in·suf·fi·cien·cy

inadequate drainage of venous blood from a part, resulting in edema or dermatosis.

venous insufficiency

Internal medicine A state in which one or more veins do not allow normal blood flow due damage of internal valves, resulting in leakage and pooling of blood in legs and feet Clinical Swelling and dull aching, heaviness, cramping of legs, discoloration of overlying skin. See Deep venous thrombosis, Stasis dermatitis, varicose veins.

ve·nous in·suf·fi·cien·cy

(vē'nŭs in'sŭ-fish'ĕn-sē)
Inadequate drainage of venous blood from a part, resulting in edema or dermatosis; most often seen in veins in the lower extremities.
References in periodicals archive ?
The efficacy and safety of a coumarin-troxerutin combination (SB-LOT) in patients with chronic venous insufficiency: a double-blind placebo-controlled randomised study.
Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol.
Valvular incompetence can be confirmed with spectral and colour Doppler, and unlike photoplethysmography and air plethysmography, venous insufficiency can be localised to specific valve sites in the deep and superficial veins.
A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein.
Pulmonary embolism, as the most severe possible complication of chronic venous insufficiency, was not encountered in any of the included patients.
A total of 1154 patients [781 females (67.68%) and 373 males (32.32%)] with complaints or symptoms of venous insufficiency (VI; such as leg edema, pain, ulcers, cramps, itching, thickening of the skin, color change around the ankles of the skin, having VVs, or feeling of tension in the legs) were included in this study
Incompetent perforating veins detected in the absence of deep venous insufficiency were localised pre-operatively with duplex and ligated or avulsed through small incisions.
Venous insufficiency was detected by performing color Doppler ultrasound of lower limb veins.
Caption: Atrophie blanche is a porcelain-white atrophic scar with surrounding pigmentation on the lower leg that occurs after skin injury in an area with venous insufficiency. In a patient with SLE, it is strong evidence of thrombotic vasculopathy.
Lee, "Prevalence and risk factors of chronic venous insufficiency," Angiology, vol.
Fifty-eight professionally active individuals without symptoms of venous insufficiency or just with telangiectasia (C0 and C1 in the CEAP classification) were included in the study.