Venous insufficiency

Question 1

Venous insufficiency

Answer 1

Failure of the venous system

Characterised by:

• valvular reflux
• venous hypertension
• obstruction

Question 2

Aetiology

Answer 2

Primary - underlying defect to the vein wall or valvular component e.g. congenital defects

Secondary - defects secondary to damage e.g. venous outflow obstruction

DVT
Valvular insufficiency
Varicose Veins

Question 3

RF

Answer 3

Increasing age
Female 
Pregnancy
Previous DVT 
Phlebitis
Obesity
Smoking

Question 4

Clinical Features

Answer 4

Chronically swollen lower limbs

• aching
• pruritic
• painful
• venous claudication - bursting pain and tightness

Examination:

• varicose eczema
• thrombophlebitis
• haemosiderin skin staining
• lipodermatosclerosis
• atrophie blanche

Question 5

Post Thrombotic Syndrome

Answer 5

After DVT

Presents with:

• heaviness
• cramps
• pain
• pruritic and paraesthesia
• pretibial oedema
• skin induration
• hyperpigmentation
• redness
• ulceration

Question 6

Ix

Answer 6

Vascular examination
Routine blood tests
Obs

Doppler USS - venous reflux

ECHO - cardiac disease exclusion

ABPI

Question 7

Mx

Answer 7

Early tx:

Conservative:

• compression stockings
• suitable analgesic control

Surgical - less successful

Question 8

Complications

Answer 8

Swelling
Recurrent cellulitis
Chronic pain and ulceration

Rare:

• DVT
• Varicose veins
• secondary lymphoedema