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Chronic venous disorder: Difference between revisions
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(Created page with "'''Chronic venous disorder''' (CVD) is an umbrella term for chronic disorders of the veins of the legs. It’s more common in women and includes disorders like '''varicose veins''' and '''chronic venous insufficiency'''. CVD is very common (as varicose veins are very common) but is mild in most cases. Chronic venous insufficiency (CVI) is a severe form of CVD, where there is oedema, skin changes, or ulceration (clinical stage C3 or higher). CVI is relatively common and...") |
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'''Chronic venous disorder''' (CVD) is an umbrella term for chronic disorders of the veins of the legs. It’s more common in women and includes disorders like '''varicose veins''' and '''chronic venous insufficiency'''. CVD is very common (as varicose veins are very common) but is mild in most cases. | <section begin="dermatology" />'''Chronic venous disorder''' (CVD) is an umbrella term for chronic disorders of the veins of the legs. It’s more common in women and includes disorders like '''varicose veins''' and '''chronic venous insufficiency'''. CVD is very common (as varicose veins are very common) but is mild in most cases. | ||
Chronic venous insufficiency (CVI) is a severe form of CVD, where there is oedema, skin changes, or ulceration (clinical stage C3 or higher). CVI is relatively common and affects up to 5% of US adults. | Chronic venous insufficiency (CVI) is a severe form of CVD, where there is oedema, skin changes, or ulceration (clinical stage C3 or higher). CVI is relatively common and affects up to 5% of US adults.<section end="dermatology" /> | ||
== Etiology == | == Etiology == | ||
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Poor flow traps WBCs in the veins, which release proteolytic enzymes which damage the capillary basement membranes. This causes plasma to leak into the interstitium, causing oedema. Oedema decreases oxygen delivery to tissues, causing inflammation and hypoxia. Extravasation of RBCs causes haemosiderosis, causing pigmentation | Poor flow traps WBCs in the veins, which release proteolytic enzymes which damage the capillary basement membranes. This causes plasma to leak into the interstitium, causing oedema. Oedema decreases oxygen delivery to tissues, causing inflammation and hypoxia. Extravasation of RBCs causes haemosiderosis, causing pigmentation | ||
<section begin="dermatology" /> | |||
== Classification == | == Classification == | ||
Chronic venous disorders are classified according to the CEAP classification, which stands for Clinical, Etiological, Anatomical and Pathophysiological. The clinical part of it is the most important and shows the clinical manifestations of CVD from least severe to most. | Chronic venous disorders are classified according to the CEAP classification, which stands for Clinical, Etiological, Anatomical and Pathophysiological. The clinical part of it is the most important and shows the clinical manifestations of CVD from least severe to most.<section end="dermatology" /> | ||
* C0 – No signs of venous disease | * C0 – No signs of venous disease | ||
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* C5 – Healed venous ulcer | * C5 – Healed venous ulcer | ||
* C6 – Active venous ulcer | * C6 – Active venous ulcer | ||
<section begin="dermatology" /> | |||
== Clinical features == | == Clinical features == | ||
There are many clinical stages of CVD, with different clinical manifestations. General symptoms include a feeling of heaviness in the leg, oedema, and pain. This pain is worsened when standing and having the leg below the body, but relieved by walking (which is, notably, opposite of that of [[Peripheral artery disease|PAD]]). | There are many clinical stages of CVD, with different clinical manifestations. General symptoms include a feeling of heaviness in the leg, oedema, and pain. This pain is worsened when standing and having the leg below the body, but relieved by walking (which is, notably, opposite of that of [[Peripheral artery disease|PAD]]). | ||
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Telangiectasia, also called spider veins, are small dilated intradermal veins. Varicose veins are superficial veins which have become dilated and tortuous to the point where they’re visible and palpable on the legs. | Telangiectasia, also called spider veins, are small dilated intradermal veins. Varicose veins are superficial veins which have become dilated and tortuous to the point where they’re visible and palpable on the legs. | ||
Skin changes can occur and cause itching, stasis dermatitis, and pigmentation changes. Lipodermatosclerosis is a localised inflammation and fibrosis of the skin, which causes induration and pain. White atrophy refers to white atrophic plaques of skin, which are white due to the absence of capillaries in the fibrotic plaques. | Skin changes can occur and cause itching, stasis dermatitis, and pigmentation changes. Lipodermatosclerosis is a localised inflammation and fibrosis of the skin, which causes induration and pain. White atrophy refers to white atrophic plaques of skin, which are white due to the absence of capillaries in the fibrotic plaques.<section end="dermatology" /> | ||
<section begin="dermatology" /> | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Chronic venous disorders are mostly a clinical diagnosis, but duplex [[ultrasound]] can show retrograde flow (reflux) and/or obstruction in the veins. Ultrasound is especially important in those considered for surgery as the presence of reflux and/or obstruction influences the choice of treatment. | Chronic venous disorders are mostly a clinical diagnosis, but duplex [[ultrasound]] can show retrograde flow (reflux) and/or obstruction in the veins. Ultrasound is especially important in those considered for surgery as the presence of reflux and/or obstruction influences the choice of treatment. | ||
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** Valvuloplasty (valve repair) | ** Valvuloplasty (valve repair) | ||
** Vein transposition | ** Vein transposition | ||
<section end="dermatology" /> | |||
The choice of procedure depends on the underlying pathomechanism (reflux, obstruction, or both) and which veins are affected (superficial, perforating, deep). | The choice of procedure depends on the underlying pathomechanism (reflux, obstruction, or both) and which veins are affected (superficial, perforating, deep). | ||
<noinclude>[[Category:Vascular surgery]]</noinclude> | <noinclude>[[Category:Vascular surgery]]</noinclude> | ||