venous stasis; venous hypertension

Etiology

• primary varicose veins
• secondary varicose veins
  • obesity
  • pregnancy
  • prolonged standing or walking
• postphlebitic syndrome
• progression of underlying disease
  • heart failyure

Pathology

• valvular incompetence with retrograde venous flow
• increased capillary pressure
• extrusion of fluid & erythrocytes into the interstitial space
• ulceration
• venous stasis dermatitis

Genetics

• family history in patients with primary varicose veins

Clinical manifestations

• unilateral or bilateral leg swelling
• exacerbated by prolonged standing or other activities that increase swelling of lower extremity
• superficial thrombosis
• dependent pitting edema
• brown discoloration due to hemosiderin deposition, especially medial ankle
• leg heaviness, tiredness
• varicose veins or reticular veins
• loss of ankle dorsiflexion & presence & severity of peripheral neuropathy correlate with venous stasis severity

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Laboratory

• renal function tests
  • urine protein
• urinalysis
• serum albumin

Radiology

• duplex ultrasound to rule in/out deep vein thrombosis if DVT suspected

Complications

• venous stasis ulcer
  • due to tissue damage or trauma to the skin
  • base of ulcer with granulation tissue
  • serosanguineous drainage
  • painful
• stasis dermatitis
  • reddish-brown discoloration of the skin with erythema & pruritus
• pruritus, eczema
• lipodermatosclerosis*

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• disease interaction(s) of venous stasis with urinary incontinence

Management

• elevation of extremity
• gradient elastic stockings of 30-40 mm Hg
  • calf-length stockings are generally adequate
  • panty hose if entire extremity is involved
• external pneumatic compression device (evenings)
  • sequential or single-chamber
• moisturing cream applied to skin
  • prevent dryness
  • diminish risk of cellulitis
• treat stasis dermatitis (pruritus, erythema)
  • topical glucocorticoids 1st line
• exercise
• in patients with chronic venous insufficiency, diuretics should be avoided because fluid mobilization from interstitial space to intravascular space does not predictably occur
• surgery may be of benefit (see ESCHAR study)
  • endovenous Nd:YAG laser surgery of saphenous vein

More general terms

• venous disease; venopathy
• peripheral vascular disease (PVD)

More specific terms

• chronic cerebrospinal venous insufficiency (CCSVI)

Additional terms

• ESCHAR study
• lower extremity edema
• stasis dermatitis; venous eczema; gravitational dermatitis
• varicose vein (varix)
• venous stasis ulcer