Classification of Venous Insufficiency: Diagnosis and Treatment
Venous insufficiency usually occurs in veins of the lower extremities and consists of mechanical problems of reflux, obstruction, or a combination of the two. The clinical process is usually slow, recurrent, and chronic. Therefore, we refer to the condition as chronic venous insufficiency. These lesions cause local venous hypertension, which results in venous stasis symptoms such as skin exanthema, pigmentation, lipodermatosclerosis, and stasis ulcers (Figures 81.1 and 81.2). The venous system consists of superficial veins, including the saphenous system, the deep vein system, and perforating veins. Reflux lesions may spread not only to the superficial venous system but also to multisegmental veins. Primary varicose veins, with reflux of superficial veins, are most often encountered clinically. Reflux flow in the deep vein system may be due to congenital valvular absences, prolapse of valves (floppy valves, primary deep vein insufficiency), dilation of valvular annuli, or postthrombotic syndrome.5 In a vein lumen occluded with thrombi, the valve cusps become fixed and are unable to function properly. If thrombolysis occurs, recanalization results in a vessel without valves. However, most obstructive disorders are caused by deep vein thrombosis due to incomplete re-canalization and the onset of acute deep vein thrombosis. Sakaguchi et al.37 reported that 80% of obstructive diseases can be improved by recanalization within 2 years, but reflux may increase. These two components, reflux and obstruction, maintain the balance of a mixed condition, but the reflux component proved superior after 10 years.
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