CVI

Question 1

Venous drainage of lower limbs?

Answer 1

Superficial system: great saphenous vein, short saphenous vein

Deep system: tibial, popliteal, femoral, iliac

Perforators moving blood from superficial to deep veins ONE WAY

venous valves preventing back flow and venous HTN

Question 2

Risk factors for CVI

Answer 2

Prolonged standing, secondary to DVT, female, obesity, lack of physical activity, family hx, parity more than 2, congenital absence of valves

Question 3

Symptoms of CVI?

Answer 3

1. Leg heaviness and aches due to prolonged standing RELIEVED by walking
2. End of day feelings of swelling (painful non pitting edema) and cramps
3. Dry itchy legs, black discoloration

Question 4

Management?

Answer 4

Calf exercises daily, avoid prolonged standing, elevate legs when possible, venotropic drugs, compression stockings changed every 6 months

Question 5

Pathophysiology?

Answer 5

Venous valve defect leads to back flow of blood and stasis, increasing V pressure and causing weakness of venous walls leading to dilation and varicose veins. V HTN leads to extravasation of RBC and WBC into subcutaneous tissue, leading to hemosiderosis and black discoloration of the skin. Also leads to release of inflammatory cytokines and local inflammation, leading to cuffing of lymphatics (-> edema) and capillaries (-> ischemia)

Question 6

Which venous system is affected in order?

Answer 6

Superficial -> perforators -> deep

Question 7

Where are the changes mainly located ? And venous ulcers?

Answer 7

In lower third of the leg (gaiter area) the ulcers are above the medial malleolus