Venous Insufficiency

What is chronic venous insufficiency?

abnormalities of venous systems in lower extremities causing pain and cutaneous manifestations

What is the most common vascular disorder in the US?

chronic venous insufficiency

What are risk factors for chronic venous insufficiency?

advancing age

pregnancy

obesity

smoking

family history of venous insufficiency

What finding is seen in C1 stage of chronic venous insufficiency?

spider veins

What finding is seen in C2 stage of chronic venous insufficiency?

varicose veins

What finding is seen in C3 stage of chronic venous insufficiency?

swelling

What finding is seen in C4 stage of chronic venous insufficiency?

skin changes

What finding is seen in C5-6 stage of chronic venous insufficiency?

venous ulcer

What is the diameter and location of telangiectasias?

<1mm

intradermal

What is the diameter and location of reticular veins?

1-3mm

subdermal

What is the diameter and location of varicose veins?

>3mm

subQ

What are telangiectasias?

small, purple, fanned out

dilated venules or capillaries

What are reticular veins?

dilated veins

bluish in color

tortuous

What are varicose veins?

large, dilated, and tortuous veins

appear raised and twisted

What is dependent edema?

ankle or lower leg swelling worse after standing and improves with leg elevation

worse at end of day

bilateral

Does dependent edema respond to diuretics?

no

What is another term for dependent edema?

pitting edema

What causes hyperpigmentation of the skin in chronic venous insufficiency?

hemosiderin deposition in dermis

What is the appearance of hyperpigmentation of the skin in chronic venous insufficiency?

brown or blue/grey discoloration at ankles and lower legs

What is the appearance of venous ulcers?

located on medial ankle

shallow and painful

irregular borders with granulation tissue

What is stasis dermatitis?

inflammatory and eczematous skin change associated with venous insufficiency

What is the pathophysiology of stasis dermatitis?

valvular dysfunction → venous insufficiency → venous hypertension → accumulation of inflammatory cells → stasis dermatitis

What clinical findings may be seen with stasis dermatitis?

erythema

scaling

eczematous patches

What is the presentation of chronic stasis dermatitis?

scaly and pruritic

dry

What is the presentation of acute stasis dermatitis?

possible erosions

inflammation

weeping plaques

vesicular rash

very pruritic

What are the treatment options for stasis dermatitis?

treat underlying venous disease

gentle emollients

topical corticosteroids

wet dressings

unna boot

What are the indications for the use of emollients?

acute and chronic stasis dermatitis

What can be used as an emollient?

fragrance free and gentle soap

vaseline

aquaphor

What are the indications for the use of topical corticosteroids?

acute stasis dermatitis

What can be used as a topical corticosteroid?

mid to high potency ointments 1-2x daily for 1-2 weeks

triamcinolone or flucinolone

What are the indications for the use of wet dressings?

acute stasis dermatitis for removal of crusts, scaling, and exudate

What are the indications for the use of unna boots?

acute stasis dermatitis

What is an unna boot?

moist bandage impregnated with zinc oxide

How do superficial bacterial infections of stasis dermatitis present?

crusting exudates

How are superficial bacterial infections from stasis dermatitis treated?

Mupirocin ointment applied 2-3x daily for 7-14 days

How should secondary cellulitis from stasis dermatitis be treated?

clindamycin PO

bactrim PO

tetracyclines PO