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Venous InsufficiencyAka: Venous Stasis, Chronic Venous Insufficiency, Lipodermatosclerosis

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  1. See Also
    1. Varicose Vein
  2. Risk Factors
    1. Obesity
    2. Congestive Heart Failure
    3. Diabetes Mellitus
  3. Pathophysiology
    1. Normal Venous valves prevent backflow
      1. Distal to Proximal vein backflow
      2. Superficial to Deep vein backflow
    2. Incompetent valves allow backflow when legs relax
      1. Results in distal venous Hypertension
      2. Primary etiology for chronic venous insufficiency
  4. Symptoms and Signs
    1. Initial Changes
      1. Varicose Veins
      2. Tan or reddish brown skin color changes
      3. Weeping and excoriated skin
      4. Pedal edema
    2. Later Changes
      1. Lipodermatosclerosis
        1. Induration at medial ankle to mid-leg
    3. Advanced Changes
      1. Brawny edema above and below fibrotic area
      2. Ulcerations
  5. Complications
    1. Venous Stasis Ulcers
      1. More common in older women
      2. Chronic and often recurrent
    2. Postphlebitic Syndrome
      1. Chronic Leg Edema
      2. Lipodermatosclerosis (see signs above)
      3. Deep Venous Thrombosis
      4. Superficial Thrombophlebitis
      5. Pigmentation
      6. Ulceration
    3. Overlying Skin Changes
      1. Eczema
      2. Cellulitis and other secondary infection
  6. Diagnosis
    1. Duplex Ultrasonound (B-Mode and Directional Pulse)
      1. Can accurately assess venous reflux
      2. Can also be used to assess Arterial Insufficiency
        1. With Ultrasound ankle/brachial index (See below)
    2. Descending Venography
      1. Not as accurate as Duplex scanning
  7. Management
    1. Confirm No Arterial Insufficiency
      1. Assess before managing Venous Insufficiency
      2. Ankle-Brachial Index
        1. Blood Pressure measurement
        2. Doppler ultraound measurement
    2. Elevate Legs above Heart 30 minutes each tid-qid
    3. Compression stockings (Jobst Stockings)
    4. Intermittent Pneumatic Compression Pumps
      1. Indications
        1. Obesity
        2. Moderate to Severe edema
      2. Contraindications
        1. Uncompensated Congestive Heart Failure
    5. Diuretics
      1. Short term use
      2. Indications: Severe edema
    6. See Venous Stasis Ulcer Management
  8. Reference
    1. Alguire (1997) J Gen Intern Med 12:374

Venous Insufficiency (C0042485)

Definition (MSH)Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
ConceptsDisease or Syndrome (T047)
ICD9459.81, 459.81
MSHD014689
EnglishPeripheral venous insufficiency, Venous Insufficiencies, Venous Insufficiency
Spanishinsuficiencia venosa periferica
Parent ConceptsOther specified diseases of circulatory system (C0155803), Vascular Diseases (C0042373), [X]Disorder of vein, unspecified (C0235522)
SourcesCOSTAR, ICD9CM, LCH, MSH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Lipodermatosclerosis (C0406500)

ConceptsDisease or Syndrome (T047)
EnglishLipodermatosclerosis, Post-phlebitic liposclerosis
Spanishlipodermatoesclerosis
Parent ConceptsPanniculitis (C0030326), Skin fibrosis NOS (C0263008), Sclerosis of the skin (C0263009), Ambiguous concept (C1274012), Dermatosis of lower limb due to disorder of leg veins (C1274160)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Chronic venous insufficiency NOS (C1306557)

ConceptsDisease or Syndrome (T047)
ICD9459.81
EnglishChronic venous insufficiency
Spanishinsuficiencia venosa cronica
Parent ConceptsVenous insufficiency of leg (C0340732)
SourcesMTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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