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).

Deep venous thrombosis Generally, thromboses are blood clots that form in a blood vessel which partially or completely block blood from flowing freely through the vessel (Weigand, 2002). More specifically and as the medical term connotes, a deep vein thrombosis is a type of blood clot that forms in veins that are located deep in the body (Weigand, 2002).

According to the National Heart, Lung & Blood Institute (2016), other terms for DVT that advanced practice nurses may encounter include the following: (a) blood clot in the leg; (b) thrombophlebitis; (c) venous thrombosis; and, (d) venous thromboembolism (VTE) (this term is used for both deep vein thrombosis and pulmonary embolism) (Other names for deep vein thrombosis, 2016, para. 2).

Although DVTs can form in the abdomen, pelvis and even the heart, the most common area where these types of thromboses form is the high or calf due to the relatively slow movement of blood through these regions of the body (Weigand, 2002).

The main risk factors for DVT include the following: A history of DVT; Some genetic conditions or factors that make blood thicker or more likely to clot than normal (such as hormone therapy or birth control pills); Injury to a deep vein from surgery, a broken bone, or other trauma; Slow blood flow in a deep vein due to lack of movement which can occur following surgery, after long periods of travel or confinement to bed; Pregnancy and the first 6 weeks after giving birth; Recent or ongoing treatment for cancer; A central venous catheter; Older age (being older than 60-year is a risk factor for DVT but DVT can occur at any age); Overweight or obesity; and, Smoking (Who.