Chronic Venous Insufficiency Flashcards
How does chronic venous insufficiency occur?
Blood does not efficiently drain from the legs back to the heart
Usually due to damage to the valves inside the veins
What causes valve damage inside the veins?
Age
Immobility
Obesity
Prolonged standing or after DVT
What is chronic venous insufficiency commonly associated with?
Varicose veins
What happens in venous hypertension?
Valves ensure blood flow in one direction as leg muscles contract and squeeze the veins
Damaged valves, leg muscles become less effective in draining blood to the heart
Blood pools causing venous hypertension
What is the gaiter area?
Area between top of the foot and bottom of the calf muscle
Chronic pooling of blood usually leads to skin changes here
What is haemosiderin staining caused by?
Chronic pooling of blood, increased pressure causes haemoglobin to be pushed out from veins
Haemoglobin then breaks down into haemosiderin and pools causing a red/brown discolouration
What causes venous eczema?
Chronic inflammatory response in the skin
Dry
Itchy
Flaky
Scaly
Red
Cracked skin
What is lipodermatosclerosis?
Hardening and tightening of the skin and tissue beneath the skin
Chronic inflammation causes subcutaneous tissue to become fibrotic
Inflammation of subcutaneous fat is called panniculitis
What is narrowing of the lower legs called?
Inverted champagne bottle appearance
What is atrophie blanche?
Patches of smooth, porcelain-white scar tissue on the skin surrounded by hyperpigmentation
What skin changes does chronic venous insufficiency lead to?
Haemosiderin staining
Venous eczema
Lipodermatosclerosis
Atrophie blanche
Cellulitis
Poor healing after injury
Skin ulcers
Pain
How is chronic venous insufficiency managed?
Keeping skin healthy
Improving venous drainage to the legs
Managing complications
How is skin kept healthy in chronic venous insufficiency?
- Monitoring skin health and avoiding damage
- Regular emollient use e.g. diprobase and oilatum
- Topical steroids to treat flares of venous eczema
- Very potent topical steroids to treat flares of lipodermatosclerosis
How is venous drainage improved in chronic venous insufficiency?
- Weight loss if obese
- Keeping active
- Keeping legs elevated when resting
- Compression stockings
How are complications of chronic venous insufficiency managed?
- Antibiotics for infection
- Analgesia for pain
- Wounder care for ulceration
