Chronic venous insufficiency

Chronic venous insufficiency, chronic venous insufficiency, CVI, varicose veins, varicosis.

Edema formation, and irreversible change in the veins, surrounding tissues and muscle fascia due to chronic. Reflux of venous blood.

• Women > men
• Prevalence: 15-50% affected depending on source

• Insufficiency of superficial, deep or transfascial veins
• May develop in connection with:
  • Primary varicose veins
  • Secondary varicose veins
  • Phlebothrombosis
  • Post-thrombotic syndrome
  • Extrinsic compression of the vein(s) (e.g., tumor, May-Thurner syndrome, obesity)

• The examination should always be performed standing up due to the hydrostatic pressure.

• Purpura jaune d'ocre: Due to increased hydrostatic pressure, erythrocyte extravasation occurs with consequent haemosiderin deposition, leading to hyperpigmentation on the lower legs.
• Hypodermatitis: Aseptic, acute inflammation of the cutaneous subcutaneous tissue. This is often painful and occurs with redness and tension (pseudoerysipelas). In the course, transition into dermatoliposclerosis.

• Dermatoliposclerosis: proteins leaking in the context of hydrostatic pressure lead to increased cutaneous and subcutaneous collagen synthesis and fibroblast stimulation.

• Atrophy blanche/ capillaritis alba: Porcelain-coloured scarring healing skin atrophy around the ankles or around an ulcer. There is an increased risk of ulceration.

• Clinical
• Phlebological examination: Exclusion of deep vein thrombosis and post-thrombotic changes, varicose vein assessment
• If necessary, measurement of the ankle-brachial index to rule out relevant arterial occlusive disease: especially in cases of ulcers (prevalence of mixed ulcers 15-20%), cardiovascular comorbidities, symptomatic PAD, absent foot pulses

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