cardiovascular disorders
Chronic Venous Insufficiency and Post Thrombotic Syndrome
Symptoms and Signs of Chronic Venous Insufficiency
Clinically evident chronic venous insufficiency may not cause any symptoms but always causes signs; post-thrombotic syndrome always causes symptoms. Both disorders are a concern because their symptoms can mimic those of acute DVT and both can lead to substantial reductions in physical activity and quality of life. Symptoms include a sense of fullness, heaviness, aching, cramps, pain, tiredness, and paresthesias in the legs; these symptoms worsen with standing or walking and are relieved by rest and elevation. Pruritus may accompany skin changes. Signs occur along a continuum: no changes to Varicose Veins (rare) to edema to Venous stasis dermatitisconsists of erythema, hyperpigmentation, induration, venous ectasia, lipodermatosclerosis (fibrosing subcutaneous panniculitis), lichenification, and venous stasis ulcers. Erythema may be difficult to appreciate in dark skin. may develop spontaneously or after affected skin is scratched or injured. They typically occur around the medial malleolus, tend to be shallow and moist, and may be malodorous (especially when poorly cared for) or painful. They do not penetrate the deep fascia. In contrast, ulcers due to Peripheral Arterial Disease eventually expose tendons or bone. Venous stasis includes lichenification and hyperpigmentation. A shallow ulcer is developing superior to the medial malleolus. © Springer Science+Business Media This large venous stasis ulcer is surrounded by brawny induration. © Springer Science+Business Media Venous stasis ulcers develop as a result of inadequately treated stasis dermatitis; they may quickly follow the first signs of stasis dermatitis. Image provided by Thomas Habif, MD. Roberto A. Penne-Casanova/SCIENCE PHOTO LIBRARY Leg edema tends to be unilateral or asymmetric; bilateral symmetric edema is more likely to result from a systemic disorder (eg, Heart Failure (HF) , hypoalbuminemia) or certain medications (eg, calcium channel blockers). In general, unless the lower extremities are adequately cared for, patients with any manifestation of chronic venous insufficiency or post-thrombotic syndrome are at risk of progression to more advanced forms. 