Venous Insufficiency Follow-up

• Patients who have had significant blood loss from a ruptured varicosity may be admitted to the hospital, particularly if the bleeding varicosity is large and if the overlying tissue is friable.

• Patients with venous insufficiency syndromes should wear compression stockings unless they also have arterial insufficiency or unless they cannot tolerate the stockings for some other reason.
• Increased pain or swelling is an indication for repeat duplex ultrasonography to rule out DVT.

• Patients should avoid prolonged standing or sitting.
• Correction of the underlying problem prevents progression of the disease.
• In patients with early venous insufficiency, progression to overt signs of disease such as stasis dermatitis, skin breakdown, and ulceration can virtually always be prevented with the use of gradient compression hose with a 30- to 40-mm Hg gradient between foot and knee.

• Common sequelae of venous insufficiency include pain and paresthesias, stasis dermatitis, nonhealing venous ulcers, hemorrhage, recurrent cellulitis, deep and superficial thrombophlebitis, pulmonary embolism, and death. The local tissue sequelae of venous insufficiency are due to a combination of high venous pressures and reduced clearance of cellular metabolites from the lower extremity. Chronic pain, swelling, recurrent cellulitis, and chronic nonhealing leg ulcers (ulcer cruris) are the most common sequelae, but they are not the most severe.
• Complications of untreated venous insufficiency

  • Recruitment of veins (High venous pressures may cause the recruitment of adjacent normal veins into refluxing circuits.)
  • Deep venous thrombosis
  • Pulmonary embolism
  • Venous ulceration
  • Secondary lymphedema
• Potential complications of surgical ablation of refluxing veins

  • Infection
  • Nerve injury
  • Arterial injury
  • Undesirable cosmetic outcomes
• Potential complications of RFA and EVLT

  • Skin burns
  • Thermal injury to adjacent tissues
  • Inadvertent injury to deep veins
• Potential complications of sclerotherapy

  • Allergic reactions to sclerosants
  • Cutaneous necrosis due to extravasation
  • Inadvertent arterial injection (may cause loss of a limb)

Without correction of the underlying cause, venous insufficiency is inexorably progressive. Subjective symptoms usually worsen over time.

In many patients, the skin eventually breaks down and nonhealing ulcers develop. A study by Abbade et al determined that longstanding and large ulcers and recurrences are the primary complications encountered by patients who have venous ulcers.^[11] Risk factors for these complications include severe lipodermatosclerosis, a previous history of ulcers, and time since first ulcer episode of 2 years or longer.

Patients have an increased lifetime risk of DVT and pulmonary embolism.

Reflux need not be entirely eliminated for the ulceration to resolve. Ulcers will heal if the net volume and pressure of reflux are reduced below a threshold level.

Tissue atrophy and staining are usually not reversible.

Venous insufficiency syndromes can also lead to death from thromboembolism or hemorrhage.

• Patients should be instructed to wear compression hose as much as tolerated.
• Patients should avoid prolonged standing or sitting. Walking or calf-muscle exercises should be performed at regular intervals.
• For patient education resources, visit eMedicine's Circulatory Problems Center. Also, see eMedicine's patient education articles Blood Clot in the Legs, Varicose Veins, and Phlebitis.