Venous Insufficiency Questions & Answers

Updated: Oct 22, 2018
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Questions & Answers

Overview

What is venous insufficiency?

What is the disease course of untreated venous insufficiency?

What is the goal of treatment for venous insufficiency?

Which three venous systems are affected by chronic venous insufficiency (CVI)?

What is the anatomy of the venous network?

How is the venous anatomy affected by venous insufficiency?

What is the pathogenesis of venous insufficiency?

What is the role of high venous pressures in the pathogenesis of venous insufficiency?

What is the role of ambulation in the pathogenesis of venous insufficiency?

What is the role of venous hypertension in the pathogenesis of chronic venous insufficiency (CVI)?

What is the association between high pressures and vein valve failure in the pathogenesis of venous insufficiency?

What are the sources of high-pressure leakage that cause venous insufficiency?

What is junctional high-pressure disease in venous insufficiency?

What is perforator high-pressure disease in venous insufficiency?

What is important to note about the presentation of venous hypertension and venous insufficiency?

What is the role of poor metabolic clearance in the pathogenesis of venous insufficiency?

How do leg ulcers develop during the development of venous insufficiency?

What factors predict the severity of venous insufficiency?

What causes chronic venous insufficiency (CVI)?

What causes the lower-extremity ulcers associated with venous insufficiency?

What is the etiology of superficial venous insufficiency?

What is the etiology of deep venous insufficiency?

What is Klippel-Trénaunay-Weber (KTW) syndrome and how does it cause venous insufficiency?

What are the signs and symptoms of venous insufficiency in Klippel-Trénaunay-Weber (KTW) syndrome?

Why is surgical treatment of venous insufficiency challenging in patients with Klippel-Trénaunay-Weber (KTW) syndrome?

What are the risk factors of chronic venous insufficiency (CVI)?

What is the prevalence of chronic venous insufficiency (CVI) in the US?

What is the global prevalence of venous insufficiency?

How does the prevalence of venous insufficiency vary by age?

How does the prevalence of venous insufficiency vary by sex?

What are the morbidities associated with venous insufficiency?

What increases the risk of deep venous thrombosis (DVT) due to venous insufficiency?

What is the cause of death in venous insufficiency?

What is the prognosis of venous insufficiency?

What information about venous insufficiency should be given to patients?

Presentation

What are symptoms of venous insufficiency?

What is the significance of varicose veins in the evaluation of venous insufficiency?

How do hormonal changes affect the presentation of superficial venous insufficiency?

What are symptoms of deep venous insufficiency?

How can pain caused by venous insufficiency be relieved?

How can venous insufficiency and arterial insufficiency be differentiated?

What worsens the pain of venous insufficiency?

Where do nonhealing ulcers typically occur in venous insufficiency?

What are the dermatologic manifestations of venous insufficiency?

What are the most common physical signs of venous insufficiency?

What is the significance of swelling in the physical exam of venous insufficiency?

What changes in skin tone and texture are characteristic of venous insufficiency?

What is the appearance of veins in venous insufficiency?

How does venous insufficiency cause nonhealing ulcers?

What are characteristics of ulcers due to venous insufficiency?

What are the limitations of physical exam in the diagnosis of venous insufficiency?

What is the role of the Trendelenburg test in the physical exam for venous insufficiency?

How is the Trendelenburg test performed to assess venous insufficiency?

What does the Trendelenburg test reveal about suspected venous insufficiency?

What are complications of untreated venous insufficiency?

What are the most common sequelae of venous insufficiency?

DDX

What conditions should be included in the differential diagnosis of venous insufficiency?

What are the differential diagnoses for Venous Insufficiency?

Workup

What is the role of lab studies in the diagnosis of venous insufficiency?

What is the role of ultrasonography in the diagnosis of venous insufficiency?

What is the role of ultrasonographic reflux mapping in the evaluation of venous insufficiency?

Which ultrasonography finding suggests severe chronic venous insufficiency (CVI) of the superficial veins?

How is ultrasonography used to diagnose deep venous thrombosis (DVT) caused by venous insufficiency?

What is the role of intravascular ultrasonography in the diagnosis of venous insufficiency?

What is the role of magnetic resonance venography (MRV) in the diagnosis of venous insufficiency?

What is the role of direct contrast venography in the diagnosis of venous insufficiency?

How is direct contrast venography performed to assess reflux in venous insufficiency?

What is the incidence of contrast-induced deep vein thrombosis (DVT) in patients treated for venous insufficiency?

What is the role of air plethysmography in the diagnosis of venous insufficiency?

What is the role of photoplethysmography in the diagnosis of venous insufficiency?

What is the role of outflow plethysmography in the diagnosis of venous insufficiency?

What is the role of physiologic venous function testing in the assessment of venous insufficiency?

What is the venous refilling time (VRT) reference range?

What venous refilling time (VRT) suggests mild and asymptomatic venous insufficiency?

What venous refilling time (VRT) suggests significant venous insufficiency?

What does a finding of venous refilling time (VRT) shorter than 20 seconds indicate in venous insufficiency?

What is the role of maximum venous outflow (MVO) testing in the evaluation of venous insufficiency?

What are the advantages of maximum venous outflow (MVO) testing to assess venous insufficiency?

What is the disadvantage of maximum venous outflow (MVO) testing to assess venous insufficiency?

What is the role of the muscle pump ejection fraction (MPEF) test in the evaluation of venous insufficiency?

How is the muscle pump ejection fraction (MPEF) test performed in the evaluation of venous insufficiency?

What is the significance of muscle pump failure during the evaluation of venous insufficiency?

What is the role of ambulatory venous pressure (AVP) monitoring in the evaluation of venous insufficiency?

Treatment

What are the goals of treatment for venous insufficiency?

What are the treatment options for venous insufficiency?

What are the treatment options for deep venous insufficiency?

What are the treatment options for superficial venous insufficiency?

Which specialist consultations are needed for the treatment of venous insufficiency?

What is the standard approach to treatment of venous insufficiency?

What is the significance of the compression gradient in the treatment of venous insufficiency?

What is the benefit of progressive compression stockings for the treatment of venous insufficiency?

What is the physical therapy approach to venous insufficiency?

Which combination therapy may be effective in the treatment of venous insufficiency?

What is the role of venoablation in the treatment of venous insufficiency?

Which venoablation technique is most effective in the treatment of venous insufficiency?

When is vein ligation indicated for the treatment of venous insufficiency?

When is sclerotherapy indicated for the treatment of venous insufficiency?

How is endovenous laser therapy (EVLT) used to treat venous insufficiency?

How is radiofrequency ablation (RFA) used to treat venous insufficiency?

What are the benefits of subfascial endoscopic perforator surgery (SEPS) for the treatment of venous insufficiency?

What is the basis for selection of surgical intervention in the treatment of venous insufficiency?

How is varicose bleeding treated in venous insufficiency?

What are the surgical options for the treatment of superficial venous insufficiency?

What is the most common surgical intervention for superficial venous insufficiency?

How is vein ligation performed in the treatment of superficial venous insufficiency?

When is ligation contraindicated for the treatment of venous insufficiency?

When is surgery indicated for the treatment of deep venous insufficiency?

What is the treatment of choice for iliofemoral disease in venous insufficiency?

What is the role of Husni bypass in the treatment of venous insufficiency?

What is the role of valvuloplasty in the treatment of venous insufficiency?

How is vein segment transposition used in the treatment of venous insufficiency?

How is vein valve transplantation used in the treatment of venous insufficiency?

What are potential complications of surgical ablation of refluxing veins in venous insufficiency?

What are potential complications of sclerotherapy for the treatment of venous insufficiency?

What are potential complications of radiofrequency ablation (RFA) and endovenous laser therapy (EVLT) for the treatment of venous insufficiency?

What is included in postprocedural care for venous insufficiency?

What activity modifications are needed following treatment for venous insufficiency?

How is venous insufficiency prevented?

What are the implications of risk factor reduction and improved treatment for venous insufficiency?

Guidelines

What is the purpose of the CEAP classification system for chronic venous insufficiency (CVI)?

What are the CEAP clinical classifications of chronic venous insufficiency (CVI)?

What are the CEAP etiologic classifications of chronic venous insufficiency (CVI)?

What are the CEAP anatomic classifications of chronic venous insufficiency (CVI)?

What are the CEAP pathophysiologic classifications of chronic venous insufficiency (CVI)?

Medications

Which medications are used for the treatment of venous insufficiency?

Which medications in the drug class Sclerosing Agents are used in the treatment of Venous Insufficiency?