Pathogenesis (disease development) Chronic venous insufficiency (CVI) is defined as hypertension (high pressure) in the venous system leading to changes in the veins and skin. Thus, venous valve insufficiency (venous valves become unable to close) occurs, resulting in recirculation, retrograde (“backward”) blood flow, and venous districts that are no longer supplied. The result is a … Chronic Venous Insufficiency: Causes
General measures Little sitting and standing A lot of walking or moving (= activation of the muscle pump). Elevating the legs for 30 minutes 4-5 times a day; this significantly reduces the tendency to edema (water retention) and improves microcirculation. Cold showering of the legs should be done regularly Foot exercise movements help to avoid … Chronic Venous Insufficiency: Therapy
Medical history (history of illness) represents an important component in the diagnosis of chronic venous insufficiency. Family history Social history What is your occupation? Does your job require you to stand or sit for long periods of time? Current anamnesis/systemic anamnesis (somatic and psychological complaints). What symptoms have you noticed? Swelling of the legs Painful … Chronic Venous Insufficiency: Medical History
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing) of the skin (lower legs and feet). Edema (swelling) of the legs Corona phlebectatica – appearance of dark blue skin veins at the edge of the foot. Atrophie blanche … Chronic Venous Insufficiency: Examination
2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification D-dimers – acute diagnosis of suspected fresh venous thrombosis (see also under “Thrombosis/Physical examination” Wells score to determine the clinical probability of venous thrombosis, DVT).
Obligatory medical device diagnostics. Duplex sonography (ultrasound examination: combination of a sonographic cross-sectional image (B-scan) and the Doppler sonography method; medical imaging technique that can dynamically visualize fluid flows (especially blood flow)) [perforator insufficiencies?] Color duplex sonography [localization of insufficient venous valves and perforating veins (connections between superficial and deep venous systems)] Optional medical device … Chronic Venous Insufficiency: Diagnostic Tests
Priority is given to conservative therapy (see Further Therapy below). In severe cases, the following operations are indicated: Open ligation of insufficient perforating veins (connections between the superficial and deep venous systems) (Wilkinson, 1986). Endoscopic ligation of insufficient (“deficient”) perforating veins; these veins connect the superficial and deep leg veins (Pierik, 1997) If necessary, for … Chronic Venous Insufficiency: Surgical Therapy
To prevent chronic venous insufficiency, attention must be paid to reducing individual risk factors. Behavioral risk factors Physical activity Standing or sitting for long periods of time (occupation) Little exercise and sports Overweight (BMI ≥ 25; obesity).
The following symptoms and complaints may indicate chronic venous insufficiency (CVI): Edema (swelling) of the legs (68%). Feeling of heavy legs (tired legs), especially after long periods of sitting and standing [no certain relationship to severity of disease]. Painful legs, especially after long periods of sitting and standing. Atrophic skin lesions Associated symptoms Atrophy blanche … Chronic Venous Insufficiency: Symptoms, Complaints, Signs
Cardiovascular (I00-I99). Leg edema in heart failure (cardiac insufficiency) (right heart failure). Leg vein thrombosis (deep vein thrombosis, TBVT) [when acute, i.e., acute, new symptoms]. Ulcus cruris arteriosum – lower leg ulcer, which is caused by peripheral arterial occlusive disease (pAVK) / progressive narrowing or occlusion of the arteries supplying the arms / (more often) … Chronic Venous Insufficiency: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by chronic venous insufficiency (CVI): Cardiovascular system (I00-I99) Thrombophlebitis, superficial (SVT); risk factors: Men: older age, smoker, positive family history of venous thromboembolism (VTE). Women: older age, BMI ≥ 25 kg/m2, positive family history of VTE. Ulcus cruris venosum (“open leg“) … Chronic Venous Insufficiency: Complications
Stage classification of chronic venous insufficiency (CVI) according to Widmer. Widmer stage Description I Swelling of the legs in the evening, reversible edema (water retention)/ankle edema overnight. Local vasodilatation (spider veins) in the ankle region and above the arch of the foot. Corona phlebectatica – appearance of dark blue skin veins at the edge of … Chronic Venous Insufficiency: Classification
