Chronic Venous Insufficiency

Question 1

Chronic Venous Insufficiency

Answer 1

a condition that occurs when the vein wall and/or valves in the leg veins do not work effectively, which impairs the ability for blood to return to the heart from the legs, resulting in venous-stasis

Question 2

Venous network in LE 3 parts

Answer 2

• Superficial, (lesser and greater saphenous)
• Deep, (anterior and posterior tibial, peroneal, popliteal, deep femoral, superficial femoral, and iliac veins)
• Perforating or communicating veins

Question 3

CVI may result from?

Answer 3

Vein wall degeneration, post-thrombotic valvular damage, chronic venous obstruction, or dysfunction of the muscular pumps.

Question 4

Edema

Answer 4

a clinically apparent increase in the interstitial fluid volume

• Develops when Starling forces are altered so that there is increased flow of fluid from the vascular system into the interstitium.
• Due to Increase in capillary pressure usually results from an elevation of venous pressure caused by obstruction to venous and/or lymphatic drainage.

Question 5

Generalized Edema

Answer 5

Due to

•Heart failure, Hypo-albumenia, nephrotic syndrome, Cirrhosis, sepsis

Question 6

Localized Edema

Answer 6

Due to

•Musculoskeletal Injury, DVT

Question 7

Pitting edema

Answer 7

1+ Barely detectable impression when finger is pressed into skin
2+ Slight indentation. 15 secs to rebound
3+ Deeper indentation. 30 secs to rebound
4+ >30 secs to rebound

Question 8

PT Implications for CVI

Answer 8

• Exercise increases muscle pump for venous return and kidney function to clear fluid
• Short walks with occupations involving prolonged sitting, weight shift in standing
• Elastic pressure stockings - effective up to knee-don’t need to go above the knee
• Compression pump - below DBP, 90 sec on: 30 sec off (Generally)
• Unna boot - Semirigid dressing, layered application from 1st metatarsal to below tibial tubercle. - Cast dries 1h, wear 7 days. Muscle contracts and presses against rigid Unna boot to force fluid proximally
• Edema massage helps prevent pitting edema, which increases likelihood of wounds - contraindications include uncompensated CHF, untreated infection or cellulitis, active cancer (check with MD), renal failure, and severe pulmonary problems