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Chronic Venous Insufficiency
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- Chronic venous insufficiency means
that blood and fluid in the veins of the legs do not drain
out properly. Because of the buildup of fluid, the legs
become swollen. Many factors may cause venous insufficiency.
Treatment depends on the cause.
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- Usually the first sign is swelling
of the leg -- most often around the ankle.
- Over time, the leg can become itchy
and brownish-red.
- Initially, the skin may be thin,
shiny, and tear easily. However, with time the skin may
become very thick and hard.
- Varicose Veins may
occur.
- Some patients complain of aching or
discomfort in the leg after standing for long periods.
- Ulcers may form -- usually just
above the ankle.
- Sometimes the ulcer can become infected and lead to Cellulitis (skin
infection).
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- Previous blood clots in the leg can
damage the veins and lead to chronic venous insufficiency.
- Previous leg injury
- Cancers in the pelvis or abdomen
can prevent blood flow out of the leg.
- Abnormal blood vessels in the legs
can prevent normal circulation out of the legs.
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- Is made by knowing the patient's
past medical history, by thorough examination, and by
eliminating other diseases as the cause of the problem.
- Vascular studies -- Doppler venous Ultrasound, or
plethysmography (various tests for measuring flow of blood)
may be ordered.
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- First, any swelling should be
reduced by keeping the legs elevated, by using compression
stockings, and by avoiding long periods of sitting or
standing.
- If the skin is inflamed, wet
compresses with saline or boric acid should be used 4 times
a day for 1 hour each time. A steroid cream can then be used
to decrease some of the inflammation (do not use a steroid
cream if the skin is infected).
- In people who have had inflamed
skin for a long time, patience and good skin care is
extremely important. Cordran, a tape containing steroid
cream, can be used for convenience.
- Zinc oxide ointment can be used to
help reduce inflammation.
- An anti-fungus cream, such as
clortrimazole or miconazole, can be used to decrease the
risk of infection and help speed healing.
- Any ulcers need to be treated
aggressively. See the section "Venous Stasis Ulcers" for
more details.
- If Cellulitis develops,
antibiotics need to be started immediately.
- Varicose Veins may
need to be removed.
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- The goal is to prevent damage to the blood vessels in the legs. People diagnosed with Thrombophlebitis
should be started on blood thinners as soon as possible.
- Legs should be kept elevated to
prevent swelling.
- Avoid long periods of standing or
sitting.
- Stockings can be used to reduce
some of the swelling in the legs.
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- People with chronic venous
insufficiency must follow the above advice for their
entire life.
- Some patients with this problem may develop blood clots in their legs that require treatment with blood thinners.
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