Chronic venous insufficiency occurs as a result from an occlusion of the
venous valves in the legs or the back flow of blood through the valves. The most common veins involved in this condition are the deep and superficial leg veins. The resulting insufficiency of venous blood results in hypertension whenever there has been a prolonged increase in venous pressure.
Chronic venous insufficiency manifests itself when venous pressure is intermittently elevated due to the characteristics of veins in general which tend to be a lot thinner and more elastic than arteries. In this state, the venous valves are stressed in reaching its maximum elasticity which consequently prevents it from fully closing allowing for the reflux of blood in the veins.
Clinical manifestations of chronic venous insufficiency
In chronic venous insufficiency, the valves in the deep veins become increasingly incompetent following an obstruction from a thrombus that has formed. This condition is best described as pooling of venous blood resulting in edema which leads to pain and pigmentation of the affected area. The individual may notice the signs and symptoms being less pronounced in the morning and becoming worse at night. Obstruction or poor calf muscle pumping in addition to valvular reflux must be present for the development of severe post thrombotic syndrome and stasis related ulcers. Superficial veins may be dilated, with such disorders being longstanding is difficult to treat and can more often be incapacitating if left untreated.
Complications of chronic venous insufficiency
Chronic venous insufficiency can ultimately result in stasis ulcers when the latter ruptures leading to subsequent ulcerations. When these vessels rupture, red blood cells escape into surrounding tissues and later degenerate leaving a brownish discoloration of the tissues. The pigmentation and ulcerations usually affect the lower part of the extremity more specifically within the ankle region. The skin becomes dry, cracks and itches leading to the subcutaneous tissues thickening as a result of fibrosis and atrophy with the risk of injury and infection of the extremities significantly increasing.
Venous ulceration is the most serious complication of chronic venous insufficiency and can be closely associated with other conditions affecting the circulation of the lower extremities such as cellulitis or dermatitis which can complicate the care of venous insufficiency and ulceration.
Management of chronic venous insufficiency
The management of patients with chronic venous insufficiency is primarily directed at reducing venous stasis and preventing ulcerations from happening. Measures that increase venous blood flow are antigravity activities such as elevating the legs, compression of the superficial veins with elastic compression stockings. Elevating the legs decreases edema, promotes venous return and provides systematic relief .
At night the individual should sleep with their
legs elevated about 6 inches above the bed. Prolonged standing or sitting is detrimental and individuals at high risk for this condition are encouraged to exercise and walk around to prevent pooling of blood. Furthermore extremities with chronic venous insufficiency must be carefully protected from trauma, the skin must be kept dry and soft at all times.
In chronic venous insufficiency, the valves of the veins become incompetent due to the increasing elasticity of the veins brought about by either an occlusion by a thrombus formation on one of the venous networks in the lower extremities.