Chronic venous insufficiency
Last Updated: 2020-08-17
Chronic venous insufficiency, chronic venous insufficiency, CVI, varicose veins, varicosis.
Edema formation and irreversible changes in veins, surrounding tissues and muscle fascia due to chronical recirculation of venous blood.
- Women > Men.
- Prevalence: 15-50% depending on source.
Classification by Widmer
Edema, corona phlebectatica paraplantaris
Stage I &
Stage I + II &
Stage I + II &
Classification according to CEAP (clinical, etiologic, anatomical, pathophysiological)
|C0||No visible signs|
|C1||Spider veins, telangiectasias or reticular veins|
|C3||Varicosis with edema|
Varicosis with trophic skin changes
|C5||C4 + healed ulcer|
|C6||C4 + florid ulcer|
- Insufficiency of superficial, deep or transfascial veins.
- Formation is possible within the scope of:
- Primary varicoses
- Secondary varicoses
- A post-thrombotic syndrome
- Due to the hydrostatic pressure, the test should always be performed standing up.
- Purpura jaune d'ocre: Due to the increased hydrostatic pressure, erythrocyte extravasation occurs with consequent hemosiderin deposition, which leads to hyperpigmentation on the lower legs.
- Hypodermitis: Aseptic, acute inflammation of the cutaneous subcutaneous tissue. It is often painful and occurs with redness and tension (pseudoerysipelas). In the course of transition to dermatoliposclerosis.
- Dermatoliposclerosis: The proteins released in the course of hydrostatic pressure lead to increased cutaneous and subcutaneous collagen synthesis and fibroblast stimulation.
- Atrophy blanche/capillaritis alba: Porcelain-coloured skin atrophy in the area of the ankles or around an ulcer, which heals in a scar-like manner. There is an increased risk of ulceration.
- Clinical features
- Phlebological examination
- Stage C2-C6:
- Compression treatment
- Pütter technique
- Compression stockings
- Stage C2: Class II
- Stage C3-C6: Class III.
- Stage C5-C6:
- Stage-specific ulcer therapy
- Compression therapy
- Exclusion of deep leg vein thrombosis.
For valve insufficiencies:
- Vein sclerotherapy
- Vein surgery
- Topical Therapy
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