The causes of chronic venous insufficiency (CVI) are those diseases that impair function of venous valves or obstruct the venous channels of the limb. Primary valvular insufficiency is believed to result from a congenital or acquired connective tissue disorder in the vein wall. Secondary insufficiency results from direct valve impairment, and follows either venous thrombosis or trauma. Aggravating factors are those that increase the venous backload or interfere with the mechanical function of the muscular pumps of the legs. These include obesity, locomotor disorders, arthropathies, neurologic disorders, pregnancy, cardiac failure, tricuspid incompetence, standing occupations, and senility. Other diseases commonly found in patients with chronic leg ulceration, which may play a role in compounding the diagnosis, impairing healing, or complicating therapy, include arterial insufficiency, rheumatoid disease, hematologic disorders, diabetes, and the vasculitides. Approximately one third of patients with CVI have a history of deep vein thrombosis, in which case it is termed post-thrombotic syndrome. Swelling is usually more marked than in nonthrombotic CVI and there is sometimes enough outflow obstruction for the patient to experience venous claudication. More often, however, the crucial finding in the post-thrombotic syndrome is the same as in nonthrombotic CVI, ie, valve reflux.
KeywordsPermeability Obesity Rubber Hydrocortisone Vasculitis
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