Clinical presentation includes increasing leg pain, fatigue, and heaviness with prolonged standing, associated with dilated tortuous veins.
More severe cases exhibit progressive skin changes, venous stasis dermatitis, lipodermatosclerosis, and frank ulceration.
Underlying venous insufficiency is most efficiently documented, localized, and graded by duplex ultrasound.
Conservative treatment requires graded compression.
Open surgical or endovenous treatment options may be used in highly selected cases.
Venous ulceration and bleeding are recognized complications.
Definition
Chronic venous insufficiency (CVI) refers to functional changes that may occur in the lower extremity due to persistent elevation of venous pressures. This most commonly results from venous reflux due to faulty valve function developing as a long-term sequela of deep vein thrombosis (DVT) and recanalization, and may also develop due to primary valvular incompetence without previous episode(s) of DVT. The term CVI is usually reserved for more advanced disease involving edema, skin changes, or frank ulcers.
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