Deep Venous insufficiency

Question 1

What is Deep Venous Insufficiency? (DVI)

Answer 1

Occurs due to a failure in the venous system characterised by valvular reflux, venous hypertension and obstruction

Question 2

What are the causes of DVI?

Answer 2

Primary- underlying defect in the vein wall or valve due to congenital or connective tissue disorder
Secondary- defects occur secondary to damage e.g. post-thrombotic disease, post-phlebitic disease, venous outflow obstruction, trauma

Question 3

What are the risk factors for DVI?

Answer 3

Increasing age, female gender, pregnancy, DVT, phlebitis, obesity, smoking, long periods of standing

Question 4

What are the symptoms of DVI?

Answer 4

Chronically swollen lower limbs, aching, pruritic and painful, venous claudication, busting pain and tightness on walking which resolved on leg elevation

Question 5

What will be present on examination of DVI?

Answer 5

Varicose eczema, thrombophelbitis, haemosiderin skin staining, lipodermatosclerosis, atrophie blanche, venous ulcers, if a prior DVT will have post thrombotic syndrome

Question 6

What are the symptoms of post thrombin syndrome?

Answer 6

heaviness, cramps, pruritic, paraesthesia, pretibial oedema, skin induration, hyper pigmentation, venous ecstasia, redness, ulceration

Question 7

What are the differential diagnosis of DVI?

Answer 7

Renal, hepatic, cardiac disease

Question 8

what are the primary investigations for diagnosing DVI?

Answer 8

Dopplers ultrasound scan assessing for the extent of venous reflex, stenosis and DVT or varicose veins, blood tests, foot pulses and ABPI

Question 9

What is the management for DVI?

Answer 9

compression stockings and analgesia, surgery is less successful but is venous stenting,

Question 10

What are the complications of DVT?

Answer 10

Swelling, recurrent cellulitis, chronic pain and ulceration, DVT, lymphedema, varicose veins