Pathophysiology and clinical management of chronic venous insufficiency and deep venous thrombosis

Disorders of the Veins and Arteries

Vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT) and frequently encountered by advanced practice nurses, making the need to understand the. epidemiology, pathophysiology, and clinical presentation of these conditions important. To this end, this paper reviews the relevant literature to provide a comparison of the pathophysiology of chronic venous insufficiency and deep venous thrombosis and a description concerning how venous thrombosis is different from arterial thrombosis. In addition, an explanation concerning how the patient factor might impact the pathophysiology of CVI and DVT is followed by a description of how a clinician would diagnose and prescribe treatment of these disorders for a patient based on the selected factor. Finally, a summary of the research and important findings concerning these foregoing issues are presented in the conclusion.

Review and Discussion

Chronic venous insufficiency

This condition typically involves an exacerbation of DVT even though nearly 50% of patients suffering from chronic venous insufficiency have not been diagnosed with DVT previously (Wilansky & Wilkerson, 2002). In addition, CVI can also be caused by the compression of a pelvic vein (typically by malignancy) as well as an arteriovenous fistula (Wilansky & Wilkerson, 2002). According to a study published by the American Heart Organization conducted by Jaff and Weinberg (2014), "Postthrombotic syndrome (PTS) is a common long-term consequence of DVT" (para 3).

The prevalence of PTS is relatively high, with approximately 60% of DVT sufferers experiencing this condition following a proximal DVT episode (Jaff & Weinberg, 2014). In addition, the study by Jaff and Weinberg (2014) notes that, "The most common clinical manifestations of PTS include swelling, skin changes and limb pain" (para. 5). An estimated 10% of DVT patients will experience severe PTS which is characterized by skin ulcerations (Jaff & Weinberg, 2014). Although these suboptimal clinical outcomes adversely affect quality of life and add significant costs to medical care for DVT sufferers, there remains a paucity of timely and relevant research concerning early diagnostic methods and evidence-based treatment protocols to date (Jaff & Weinberg, 2014). While additional research is needed, the National Institutes of Health (2016) report that what is known for certain at present is that the following represent risk factors for DVT:

Older age;

Family history of DVT;

Female gender (related to levels of the hormone progesterone);

History of deep vein thrombosis in the legs;

Obesity;

Pregnancy;

Sitting or standing for a long periods; and,

Tall height (Venous insufficiency, 2016, para. 3).

Conclusion

The research showed that vein and artery disorders such as chronic venous insufficiency and deep venous thrombosis share many of the same risk factors, including older age, obesity, a family history of these conditions, pregnancy and diminished movement of the legs. Notwithstanding these risk factors, however, the research also showed that anyone can experience these conditions, and advanced practice nurses should implement preventive care and remain vigilant for the manifestation of the symptoms of DVT and CVI.