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Venous Disease - Chronic Venous Insufficiency

Description of Clinical Program
What is Chronic Venous Insufficiency and what causes it?

Chronic venous insufficiency (CVI) is a condition caused by long-term blockage of the veins of the legs. This causes the blood to back-up and cause damage to the tissues of the legs. It can be caused by having leaky valves in the veins, which prevents the return of blood from the legs to the heart. Also, CVI can be caused by an obstruction in the veins due to repeated clots or bouts of inflammation. The back-up of blood into the legs causes the legs to swell (edema) and take on golden or brownish tone. The tissue can also become hard (wooden) and in severe situations, ulcers can develop. CVI can be diagnosed by venous ultrasound (duplex), phethymography (see above) or (less frequently) by injecting contrast into the veins and taking x-rays (venogram).

What are Venous Stasis Ulcers?

Venous stasis ulcers are ulcers on the leg caused by CVI. This happens because the back-up of blood prevents fresh blood with oxygen and nutrients from reaching the skin. The skin can break down and form ulcers. These usually occur on the outside of the leg, a few inches above the ankle. Because fresh blood is prevented from reaching the skin, these ulcers are very slow to heal.

How can you treat Venous Stasis Ulcers?

The great majority of venous stasis ulcers can be treated with conservative care (90-95%). This includes meticulous skin care, dressing changes, elevation of the leg, and elastic compression stockings. In severe cases, a special dressing can be applied which can be wrapped around the leg and foot, called an Unna boot. This boot has medication in the bandages and will compress as it dries, to help squeeze out the old blood. The Unna boot is changed every week until the ulcer has healed. Many other dressings that provide leg compression have been used to treat venous stasis ulcers. These include Dynaflex, Cadexomer, Rodene, Polymem and Profor.

How can you prevent Venous Stasis Ulcers?

Once the ulcers heal, the patient needs to wear graduated support stockings to prevent leg swelling. Walking and exercise of the legs are also important to help pump blood out of the leg and further reduce swelling. These measures will help to keep blood from backing up in the legs and prevent the formation of ulcers.

Is surgery ever indicated for CVI?

Surgery is only done in CVI in very rare circumstances. This is usually only after the conservative treatment has failed in a compliant patient. There are a number of complicated operations that have been attempted to treat CVI, with very little success. Some of these include doing venous bypass operations, repairing damaged valves in the vein and tying off leaky perforating veins.

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