Chronic venous disease
Venous anatomy
Pathophysiology of chronic venous disease
Contributing factors
Obstruction of venous return (eg, pregnancy, obesity)
?Orthostatic pressure (eg, prolonged standing)
Decreased muscular compression (eg, sedentary lifestyle)
Damaged venous valves (eg, d/t deep vein thrombosis)
Clinical presentation
Differential diagnosis
Classification of chronic venous disease
CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) Classification
Clinical Classification
C0 No visible or palpable signs of venous disease
C1 Telangiectasias, reticular veins
C2 Varicose veins
C3 Edema without skin changes
C4 Skin changes, including pigmentation, eczema, lipodermatosclerosis, and atrophie blanche
C5 Healed venous ulcer
C6 Active venous ulcer
Etiologic Classification
Ec Congenital
Ep Primary
Es Secondary (postthrombotic)
En No venous etiology identified
Anatomic Classification
As Superficial veins
Ap Perforator veins
Ad Deep veins
An No venous location identified
Pathophysiologic Classification
Pr Reflux
Po Obstruction
Pr,o Reflux and obstruction
Pn No venous pathophysiology identifiable
Stasis dermatitis
Chronic erythema, fibrosis, and reddish-brown discoloration d/t deposition of hemosiderin (from breakdown of extravasated red cells).
Symptoms are typically bilateral, and usually worse at or above the ankles.
Diagnostic testing
Treatment
Supportive measures
Medical therapies
Interventional and surgical therapies
Lymphedema
Lymphatic anatomy
Etiology
Clinical presentation
- Early: soft skin with pitting edema
- Progressive deposition of subcutaneous collagen and adipose tissue
- Later: firm, thickened skin and nonpitting edema.
- Advanced: skin may develop a warty appearance.
Differential diagnosis
- Venous valve incompetence
- Patients with lymphedema tends to have unilateral symptoms and history of recurrent cellulitis.
Diagnostic testing
- Stemmer sign
- Inability to lift the skin on the dorsum of the second toe.
- Highly specific.
Treatment
Weight loss, limb elevation, compression bandage, and physiotherapy (eg, lymphatic drainage by massage)
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