Vascular: Deep Venous Insufficiency

Question 1

Outline the pathophysiology of deep venous insufficiency

Answer 1

failure of the venous system, characterised by valvular reflux, venous HTN and obstruction

Question 2

What is the aetiology of deep venous insufficiency?

Answer 2

Primary = underlying defect to vein wall or valvular component, includes congenital defects and connective tissue disorders

Secondary = result from damage, including post-thrombotic disease, post-phlebitic disease, venous outflow obstruction, and trauma

Question 3

What are the risk factors for deep venous insufficiency?

Answer 3

Increasing age

Female

Pregnancy

Previous DVT or phlebitis

Obesity

Smoking

Occupation with periods of long standing

Question 4

What are the symptoms of deep venous insufficiency?

Answer 4

Chronically swollen lower limbs

Aching

Pruritic

Pain

Varicose eczema (dry and scaly skin)

Thrombophlebitis (inflam of a vein)

Haemosiderin skin staining

Lipodermatosclerosis (inflam of subcutaneous fat)

Atrophie blanche (ivory-coloured stellate scars on the legs)

Varying degree of dependent pedal oedema

Venous ulcers

Post thrombotic syndrome = heaviness, cramps, pain, pruritic, and paraesthesia, pretibial oedema, skin induration, hyperpigmentation, venous ectasia, redness, and ulceration

Question 5

What investigations should be performed when deep venous insufficiency is suspected?

Answer 5

Doppler US = asses extent of venous reflux, stenosis, DVT, varicose veins

Bloods = FBC, U+Es, LFTs

ECHO

Foot pulses

ABPI

Question 6

How is deep venous insufficiency managed?

Answer 6

Analgesics

Compression stockings

Elevate the feet above the level of the heart

Severe = deep venous stenting

Question 7

What complications can occur as a result of deep venous insufficiency?

Answer 7

Swelling

Recurrent cellulitis

Chronic pain

Ulceration