Chronic Venous Insufficiency/Post-phlebitic SyndromeThe Vascular Surgery team at the University of Michigan consists of world class surgeons and clinicians dedicated to providing exceptional patient care for Chronic venous insufficiency or post-phlebitic syndrome. Treatment for this condition is available in our state-of-the-art University of Michigan Cardiovascular Center (CVC), as well as at our Livoina Vein Center outpatient clinic. What is Chronic venous insufficiency or post-phlebitic syndrome?Chronic venous insufficiency or post-phlebitic syndrome is a decrease in function of the venous system due to non-working valves. These non-working valves may be caused by a previous DVT, though they can happen without a previous deep venous thrombosis. Incompetent valves lead to two-way venous flow and ineffective venous return to the heart. This results in high venous blood pressure, dilation and valvular insufficiency of additional veins not previously involved. Signs or symptoms that may develop are:
The skin discoloration is caused by the breakdown of red cells in the blood as it goes through this high pressure area and releases hemosidern or iron into the skin tissue. The skin in this area normally becomes dry and flaky causing itching. With continued inflammation and irritation, this can lead to the initial skin breakdown that may progress from an eczema to an ulcer. The ulceration may be multiple and occurs more often in the inside part of the ankle than the outside. The ulcer margins are usually irregular and its base is uneven. Treatments for Venous DiseaseAll treatment for venous disease focus on improving venous return. This can be achieved with an aggressive program of the wearing of surgical support stockings, intermittent leg elevation, and good exercise. Prescribed compression stockings from knee-high to thigh lengths can be worn, and these put uniform external pressure on the legs to move flow from the superficial to the deep venous systems, and from the foot to the heart. Chronic Venous Insufficiency/Post-phlebitic Syndrome TreatmentThis can be treated with elevation of the limb above the level of the heart, graduated compression stockings, walking and/or active leg exercise, and using moisturizing cream or lotion. More severe chronic venous insufficiency may be present with the occurrence and recurrence of ulceration. The control of swelling is a key factor involved in the healing and prevention of ulcers. There are many types of dressings that can be used. However, venous flow must be improved by elevating the leg above the level of the heart and by elastic bandages or stockings that externally assist in returning blood to the heart. It may take many weeks to many months for an ulcer to heal. Once healing has occurred, these same measures must be employed in an effort to prevent further ulceration. In a small number of people with chronic venous insufficiency and recurrent ulceration, surgery may be a treatment option. Sometimes, there is reversal of flow in one or more veins that connect the superficial and deep venous systems. Surgery which involves tying off this diseased vein will often improve return. If the superficial venous system is found to have reflux, saphenous vein ablation may be indicated. Additionally, when a portion of the deep system is totally blocked, it may be possible to reroute venous blood flow through surgery. Finally, if the problem is pure blood reflux (pooling), then a valve repair or valve transplant may be indicated. |
