deep venous insufficiency

Question 1

what is deep venous insufficiency?

Answer 1

a chronic disease

commonly caused by either DVT or valvular insufficiency and with varicose veins in the superficial venous system, it is part of a chronic venous insufficiency.

Question 2

what does DVI occur as the result of and how is it characterised?

Answer 2

occurs as a result of failure of the venous system
this is characterised by

• valvular reflux
• venous hypertension
• obstruction

Question 3

what are the primary and secondary causes of DVI?

Answer 3

• primary = underlying defect to the vein wall or valvular component
• secondary = defects occur secondary to damage. Includes post thrombotic disease, post phlebitic disease, trauma and venous outflow obstruction.

Question 4

what are the risk factors for DVI?

Answer 4

• increasing age
• female gender
• pregnancy
• previous DVT
• phelbitis
• obesity
• smoking
• long periods of standing
• FH of venous disease

Question 5

what are the clinical features of deep venous insufficiency?

Answer 5

• chronically swollen lower limbs which can become aching, pruritic and painful
• may also report venous claudication, characterised by a bursting pain and tightness on walking that resolves on elevation

Question 6

on examination, wha signs can indicate an underlying DVI?

Answer 6

• varicose eczema
• pitting oedema
• thrombophlebitis
• haemosiderin skin staining
• lipodermatosclerosis
• atrophie blanche

Question 7

what is post thrombotic syndrome?

Answer 7

post DVT patients may complain of this

symptoms include

• heaviness
• cramps
• pains
• pruitic
• paraesthesia
• pre tibial oedema
• skin induration
• hyper pigmentation
• venous ectasia
• redness
• ulceration

Question 8

what differentials can be made for patients presenting with leg swelling?

Answer 8

• renal
• hepatic
• cardiac disease

Question 9

what investigations are done into DVI?

Answer 9

• doppler US is gold standard to asses venous reflux
• if there is evidence of venous reflux or occlusion in femoral veins or varicosities over perineum/buttock, MR venogram can be done
• bloods to exclude any other aetiologies and ECHO to rule out cardiac disease
• document foot pulses and ankle brachial pressure index (ABPI)

Question 10

how is DVI managed ?

Answer 10

• early treatment essential
• compression stockings
• analgesic control
• 4 layer bandage compression treatment for venous ulceration
• elevate feet above heart level to alleviate symptoms and disease progression
• surgical management isn’t very successful

Question 11

what are the complications of DVT?

Answer 11

• swelling
• recurrent cellulitis
• chronic pain
• ulceration
• DVT
• secondary lymphoedema
• varicose veins