Chronic venous insufficiency: pathophysiology, clinical presentation, and management

Pathophysiology

What's Gone Wrong?

CVI is generally an indication of blood stasis or venous reflux, most commonly valvular incompetence in the low-pressure superficial venous system. The inability of blood to return to the heart from the legs causes it to pool and clot. CVI generally occurs within the deep veins (Deep Vein Thrombosis), may also be related to varicose twisting, valve malformations or pelvic tumors.

Risk Factors

Obesity, inactivity, pregnancy, smoking and extended periods of standing or sitting tend to be the activity factors of most importance. Women often present varicose veins; men DVT but this may be associated with delayed reporting. Type II Diabetes may also suggest different gender propensities. People over 50 predominately display indicators.

Relation to Pathophysiology

Signs particularly associated with work, age or other disease conditions are considered the best predictors of CVI. Congenital vein weakening can be tied to certain conditions (sickle cell), exacerbating the likelihood of CVI onset. Progressive diabetic indicators can present compounding conditions. Treatment should be planned accordingly.

Diagnostic Representations

Patients typically experience the symptomology with pain originating in the groin region or mid-proximal thigh. Large vein involvement in the calf can present in proximal calf with vein dilation extending upwards. Diagnosis is generally confirmed via Duplex ultrasound or Magnetic Resonance Venography.

COLLABORATIVE Management

Management Plan

CVI is a progressive condition. Treatment plans should be developed around in accordance with the signs and symptoms, and be developed to support preventive monitoring.

Management Options

Compression Stocking

Skin Care

Antibiotics

Sclerotherapy

Endovenous Thermal Ablation

Physicians & Preventive Nursing:

Under certain conditions, more invasive responses may be needed.

Ligation & Stripping

Miscroincision/Ambulatory Phlebectomy

Vein Bybass

Preventative guidelines that can be monitored by supportive or nursing staff:

Regular Exercising

Reduced prolonged sitting or standing

Loose and unrestricted clothing

Weight Reduction

Supportive skin treatment

Two-Armed PREVENTION for MEN

People often associate CVI with varicose veins, and as such assume women mostly need to be concerned. Growing awareness suggests that while women may demonstrate visible indicators earlier, it may also be that this linked to the fact that men are less likely to report symptoms.

There are also indications that physicians and nurses should consider simple changes in their monitoring routines. Taking blood pressure readings from both arms, for example, has been shown to increase the likelihood that symptoms may be identified earlier.

A 15mm difference in pressure readings between limbs has been associated with a 2.5 fold extra risk in of peripheral vascular disease!

References & Resources

A growing number of hospitals and public resources are being developed for CVI. The following sites are recommended and have been used for this publication:

PUBLIC RESOURCES:

Vascular Disease Foundation, http://www.vdf.org/diseaseinfo/cvi/

TREATMENT & HOSPITAL RESOURCES

Cleveland Clinic, http://my.clevelandclinic.org/disorders/venous_insufficiency/hvi_chronic_venous_insufficiency.aspx.

UC Davis, California,

http://www.ucdmc.ucdavis.edu/vascular/diseases/cvi.html

PUBLICATION REFERENCES

Collins, L.M. (2012). Taking blood pressure in both arms may find silent heart disease. Viewable: http://www.deseretnews.com/article/700220373/Taking-blood-pressue-in-both-arms-may-find-silent-heart-disease.html

Weiss, R. (2012). Venus Insufficiency. Medscape Reference. Viewable at http://emedicine.medscape.com/article/1085412-overview.

CVI

CV You

Chronic Venus Insufficiency