Chronic Venous Insufficiency

Question 1

How does blood normally return to heart from lower limbs in the absence of pathology?

Answer 1

Venous blood travels in superficial veins (great and small saphenous veins) which drain into deep veins

• Great saphenous vein drains into femoral vein at sapheno-femoral junction
• Small saphenous vein drains into popliteal vein at sapheno-popliteal junction
• perforating veins connect superficial and deep veins to allow drainage

Muscle pumps compress intramuscular veins
Valves prevent back flow

Question 2

What is ambulatory venous pressure?

Answer 2

Venous pressure after action of calf pump and valves reduces the venous pressure from that at the level of the heart
I.e. AVP= 25mmHg

Question 3

What is chronic venous insufficiency?

Answer 3

Blood doesn’t drain back to heart from leg due to damage to valves in veins leading to venous hypertension

Question 4

What are the risk factors for developing chronic venous insufficiency?

Answer 4

Age 
Immobility 
Obesity 
DVT 
Varicose veins

Question 5

Skin changes are commonly associated with chronic venous insufficiency. Where do these changes occur and what are the different types?

Answer 5

Gaiter area= between top of foot and bottom of calf muscle

Haemosiderin staining= red/brown discoloration due to leakage of Hb

Venous/varicose eczema= chronic inflammatory response induced due to venous hypertension
I.e. dry, itchy, flaky, scaly red skin

Lipodermatosclerosis= fibrosis of SC tissue due to chronic inflammation of SC (panniculitis)

Atrophie Blanche= smooth white scar tissue surrounded by hyperpigmented skin

Question 6

What is panniculitis and what is the classical appearance of this?

Answer 6

Inflammation of subcutaneous fat due to venous hypertension

Inverted champagne bottle= narrowing of lower legs

Question 7

How can the skin changes associated with venous insufficiency be managed? What condition is important to exclude in the patients?

Answer 7

Avoid skin damage
Skin moisturisers= Diprobase or Oilatum
Topical steroids= flares of venous eczema or lipodermatosclerosis
Improve venous drainage= GCS + keep legs elevated at rest

Cellulitis= infection of skin i.e. patients at risk due to increase risk of skin damage
= needs Abx