Venous insufficiency
Definition
Venous insufficiency refers to inadequate drainage of venous blood from the body part usually resulting in edema and skin abnormalities and ulceration.
Chronic venous insufficiency refers to venous insufficiency that persists over a long period of time.
Fig. 1: Venous insufficiency- edema
Causes of Venous Insufficiency:
Aging
Lack of exercise
Obesity
Pregnancy
Long hour of standing or sitting
hereditary
Clinical presentation:
Swelling of unilateral or bilateral lower extremities (Fig. 1).
Complaints of itching, fatigue, aching, heaviness in involved limbs.
Screen gingers including hemosiderin staining and lipodermatosclerosis.
Fibrosis of dermis
Increase in skin temperature of lower legs
Wounds:
Located on lower extremities proximal to the medial malleolus.
Dull leg pain, which is relieved with elevation
Granulation tissues are present in the wound bed
The tissue is bad from a large amount of draining exudate.
Signs and symptoms of lymphedema.
Measurement and Test for Venous Sufficiency
Girth Measurement
Circumferential measurements of involved and uninvolved limbs are used to determine edema.
Measurements are taken at predetermined and consistent distance apart, such as 8 or 10 cm apart.
Percussion Test
This test is used to evaluate the valves of the greater saphenous vein.
Commonly done in patients with varicosities.
Procedure:
Ask the patient to stand until the veins in the legs appear to fill.
While palpating a portion of the saphenous vein below the knee, sharply percuss a portion of a vein above the knee.
If valves are not functioning adequately, the examiner will feel a backflow of fluid distalward under the palpating fingertips.
Homan's Sign
The patient is supine, knee extended, passively dorsiflex the ankle and gently squeeze the posterior calf muscles.
If the patient experiences pain in the calf, the Homan's sign is positive.
This is not a definitive test for the presence of a DVT
Response to compression of the limb with BP cuff
Inflate the cuff until the patient experiences calf pain.
A patient with acute thrombophlebitis cannot tolerate pressure above 40mmHg.
Doppler Ultrasonography
A noninvasive assessment to determine the relative velocity of blood flow in the arteries and veins.
👉 Doppler Ultrasonic evaluations are not commonly performed by therapists.
Venous Duplex Scanning
A noninvasive diagnostic tool.
Venography
An invasive procedure involves the injection of radiopaque dye and visualization of the venous system by x-ray.
Fig. 2: Varicose vein
Management of Chronic Venous Insufficiency and Varicose Veins
Manual lymphatic drainage to prevent or minimize edema.
Use of pressure gradient support stockings.
Support garments are worn during exercise and ambulation.
Lightweight exercises (walking) on regular basis.
Elevate the lower extremities after graded ambulation until the HR returns to normal.
Avoid prolonged periods of standing still or sitting with legs dependent.
Elevate involved limbs above the level of the heart (30°-45°) when resting or sleeping.
Relaxation and active ROM exercises (pumping exercise) of distal muscles while the involved limb is elevated.
Give proper skincare to prevent skin abrasions, ulcerations, and wound infections.
Venous insufficiency refers to inadequate drainage of venous blood from the body part usually resulting in edema and skin abnormalities and ulceration.
Chronic venous insufficiency refers to venous insufficiency that persists over a long period of time.
Fig. 1: Venous insufficiency- edema
Aging
Lack of exercise
Obesity
Pregnancy
Long hour of standing or sitting
hereditary
Swelling of unilateral or bilateral lower extremities (Fig. 1).
Complaints of itching, fatigue, aching, heaviness in involved limbs.
Screen gingers including hemosiderin staining and lipodermatosclerosis.
Fibrosis of dermis
Increase in skin temperature of lower legs
Wounds:
Located on lower extremities proximal to the medial malleolus.
Dull leg pain, which is relieved with elevation
Granulation tissues are present in the wound bed
The tissue is bad from a large amount of draining exudate.
Signs and symptoms of lymphedema.
Girth Measurement
Circumferential measurements of involved and uninvolved limbs are used to determine edema.
Measurements are taken at predetermined and consistent distance apart, such as 8 or 10 cm apart.
Percussion Test
This test is used to evaluate the valves of the greater saphenous vein.
Commonly done in patients with varicosities.
Procedure:
Ask the patient to stand until the veins in the legs appear to fill.
While palpating a portion of the saphenous vein below the knee, sharply percuss a portion of a vein above the knee.
If valves are not functioning adequately, the examiner will feel a backflow of fluid distalward under the palpating fingertips.
Homan's Sign
The patient is supine, knee extended, passively dorsiflex the ankle and gently squeeze the posterior calf muscles.
If the patient experiences pain in the calf, the Homan's sign is positive.
This is not a definitive test for the presence of a DVT
Response to compression of the limb with BP cuff
Inflate the cuff until the patient experiences calf pain.
A patient with acute thrombophlebitis cannot tolerate pressure above 40mmHg.
Doppler Ultrasonography
A noninvasive assessment to determine the relative velocity of blood flow in the arteries and veins.
👉 Doppler Ultrasonic evaluations are not commonly performed by therapists.
Venous Duplex Scanning
A noninvasive diagnostic tool.
Venography
An invasive procedure involves the injection of radiopaque dye and visualization of the venous system by x-ray.
Fig. 2: Varicose vein
Manual lymphatic drainage to prevent or minimize edema.
Use of pressure gradient support stockings.
Support garments are worn during exercise and ambulation.
Lightweight exercises (walking) on regular basis.
Elevate the lower extremities after graded ambulation until the HR returns to normal.
Avoid prolonged periods of standing still or sitting with legs dependent.
Elevate involved limbs above the level of the heart (30°-45°) when resting or sleeping.
Relaxation and active ROM exercises (pumping exercise) of distal muscles while the involved limb is elevated.
Give proper skincare to prevent skin abrasions, ulcerations, and wound infections.
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