Venous Insufficiency

Chronic venous insufficiency (CVI) results from failure of the valves in deep or superficial veins. Venous anatomy in the legs is uniquely designed to allow blood to flow against the force of gravity. One-way valves in the veins close at the end of each pulsitile burst of blood upward toward the heart, ensuring unidirectional blood flow. A damaged valve with bi-directional blood flow can allow blood to flow back from the deep venous system into the superficial venous system.

Over time, the weight of this column of blood causes fluid and protein to exude into surrounding tissues where it leaks and pools in the legs and feet. Chronic venous insufficiency can cause discoloration of the skin of the ankles and may lead to tissue breakdown, and ulceration. Venous ulcers are most commonly found around the ankle. They have irregular borders and are more likely to have copious drainage than other ulcer types.

The following conditions indicate an increased risk for venous ulceration:

• A history of deep vein thrombosis, which can damage vein valves
• A family history of venous disease
• Lower-extremity edema, which increases the risk of tissue breakdown.

Treatment is particularly difficult because the damaged vein valves can't be repaired, so there's always the potential for new ulcers to form. Addressing the underlying pathophysiology is necessary to prevent recurring episodes of ulceration, that can lead to serious complications. Although hospitalization usually isn't necessary, some patients with venous ulcers must be admitted for treatment of cellulitis, which requires intravenous antibiotics.

Management of CVI and prevention of venous ulceration requires attention to the underlying venous hypertension and edema. Leg elevation and external compression are the conventional treatments.