Chronic Venous Insufficiency

Question 1

What are the risk factors for chronic venous insufficiency?

Answer 1

• Previous DVT (recanalisation)
• Age
• Smoking
• Family history
• Occupation (long periods of standing)

Question 2

What are likely findings on presentation in a patient with chronic venous insufficiency?

Answer 2

• Ankle swelling and venous flare
• Leg fatigue/aching
• Hyperpigmentation (haemosiderin)
• Itchy, dry skin
• Telangiectasia
• Ulcers
  
  • Irregular, painless, ruddy/granulating
  • Around anterior tibia/ankle

Question 3

How do venous ulcers generally differ from arterial ulcers?

Answer 3

• Disease context
  
  • e.g. signs of PVD
• Arterial ulcers are generally:
  
  • More painful
  • Regular
  • Pale
  • Surrounded by necrotic tissue

Question 4

How might you investigate suspected venous insufficiency?

What are the management principles?

Answer 4

• Doppler ultrasound
• Minimise oedema
  
  • Compression stockings
• Skin changes
  
  • Moisturiser
• Reflux minimisation
  
  • Pentoxifylline
  • Ablation

Question 5

How are varicose veins defined?

Answer 5

• Subcutaneous, permanently dilated veins 3 mm or more in diameter when measured in a standing position.

Question 6

How are varicose veins managed?

Answer 6

• Lifestyle - avoid standing and elvate leg where possible, use compression stocking
• Surgical - ablation or stripping