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Venous Insufficiency

What is venous insufficiency?
The cessation or decrease of venous flow due to high pressure exerted in deep and superficial veins. This is a result of inadequate venous valves impairing venous drainage creating edema in the lower extremities. Venous insufficiency is typically a result of reflux through the superficial veins.

What creates venous stasis ulceration?
This occurs after prolonged periods of increased pressure in superficial or deep veins. As the pressure increases, stasis of venous flow begins. The valves become ineffective allowing a backflow of venous blood into the extremities. Venous congestion results in the development of edema. The tissue is unable to receive proper oxygenation and ulceration occurs.

Facts and Statistics
•	Approximately 40% of the population will suffer with venous insufficiency during their lives.
•	On average, 1 million Americans will go on to develop venous stasis ulcers.
•	Approximately 100,000 people become disabled as a result of venous insufficiency.
•	Women are more likely to develop superficial vein disease than men.
•	Risk for venous disease increases with age.

Diagnostic Testing
Physical examination alone is not completely reliable. Additional testing is required to determine if the source of the vascular problem is arterial. Determination must be confirmed that symptoms are not a result of a deep venous thrombosis. A Trendelenburg test, Duplex Ultrasound, and Magnetic Resonance Venography among others are used to determine the source of the condition.

Prognosis
Without treatment, subjective symptoms worsen, skin breaks down and ulcerations develop. These patients have an increased risk of deep vein thrombosis and pulmonary embolism. Venous insufficiency disease may eventually lead to death.

Treatment
Superficial venous disease can be treated successfully with a multi-disciplinary approach including:
•	Maintenance of an infection free wound
•	Medicated dressings to promote wound healing
•	Treatment to assure absorption of excess drainage
•	Maintenance of a moist wound environment
•	Gradient compression bandaging
•	Gradient compression garments
•	Pneumatic compression pumps
•	Deep vascular incompetence is more difficult to treat and may require more invasive measures of intervention

Reasons for vascular failure
•	Superficial venous incompetence is the most common form of venous disease. Deep veins are normal, however blood escapes and flows backward creating venous ulceration.
•	Direct injury
•	Phlebitis
•	Congenital weakness in the veins
•	Congenital abnormality of the veins
•	Hormonal changes (pregnancy)
•	Deep venous incompetence is created by blockage or abnormality of the vessel obstructing the flow of blood.
•	Valvular insufficiency
•	Deep vein thrombosis
•	Post-phlebetic syndrome

Physical signs of venous insufficiency
•	Edema
•	Hyperpigmentation
•	Venous dermatitis
•	Chronic cellulitis
•	Non-healing ulceration (primarily noted on the medial aspect of the ankle)
•	Lymphatic edema (a result of lymphatic obstruction or secondary to venous insufficiency)

Frequently noted subjective symptoms
•	Burning	•	Heaviness
•	Throbbing	•	Fatigue
•	Cramping	•	Restless Legs
•	Ache	•	Restless Legs
Superficial venous complaints are usually intermittent. Symptoms improve with walking and elevation of the legs. Application of cold is tolerated much better than warm. Compression garments are effective for prevention of pain. Deep venous symptoms are usually symptomatic and worsen with walking but improve with elevation of the legs.

Complications of untreated venous insufficiency
•	Deep vein thrombosis
•	Pulmonary embolism
•	Venous ulceration
•	Secondary Lymphedema

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