Venous Disease at a Glance
- One percent to 3% of US health care expenses are for peripheral venous diseases and their complications.
- Venous ulcers are the most common.
- Risk factors include genetics, obesity, female gender, pregnancy, occupations requiring prolonged standing, surgery, trauma, and malignancies.
- Peripheral venous disease should be considered part of a spectrum including the following:
- Early signs: tenderness, edema, hyperpigmentation, and varicose veins.
- Late signs: atrophie blanche, lipodermatosclerosis, and venous ulcers.
- Venous ulcers are located exclusively below the knee after venous pump failure, most often secondary to prior thrombosis.
- Treatment for all stages includes leg elevation, compression, treatment of infection, and dermatitis.
- Deep venous disease is associated with thromboembolism.
Chronic disease of the peripheral veins includes a spectrum of diseases ranging from edema and tenderness to venous ulceration (Box 174-1).
Box 174-1 Common Signs and Symptoms of Peripheral Venous Disease |Favorite Table|Download (.pdf)
Box 174-1 Common Signs and Symptoms of Peripheral Venous Disease
- Leg fullness
- Aching discomfort
- Nocturnal leg cramps
- Bursting pain on standing
- Stasis dermatitis
- Varicose veins
- Venous ulcers
- Atrophie blanche
- Acroangiodermatitis of Mali
- Postphlebitic syndrome
Veins are thin-walled, distensible, and collapsible structures that function to transport blood toward the heart and act as a reservoir for preventing intravascular volume overload. Microscopically, veins consist of an intima, media, and outer collagenous adventitia. All peripheral veins contain endothelium lined, semilunar, venous valves, which promote unidirectional blood flow toward the heart. Vascular endothelium is described in detail in Chapter 165 and the anatomy of the venous system of the lower extremities is described in Chapter 249.
Chronic venous disease is extremely common. Although estimated costs and time lost from work have not been objectively assessed in over two decades, estimates state that 6–7 million people in the United States have evidence of venous stasis and that it accounts for 1% to 3% of the total health care budgets in countries with developed health care systems.1
Risk factors for chronic venous disease include heredity, age, female sex, obesity, pregnancy, prolonged standing, and greater height.2
Etiology and Pathogenesis
Venous ulcer occurs after failure of the calf muscle pump (Fig. 174-1). The heart pumps blood down to the foot; the calf muscle pump (when upright), returns venous blood to the heart. Venous blood from the skin and subcutis collects in the superficial venous system including the greater and lesser saphenous veins and its tributaries, moves through the fascia in a series of “perforating” or “communicating” veins, and fills the muscle-enveloped deep venous system. With muscle contraction, the deep veins are compressed; one-way valves in the deep system allow the now high pressure flow to move ...