흔한 질병: Chronic venous insufficiency 만성정맥부전

병원에서 흔히 보게 되는 presentation 에 대해 좀 알아보자. 

 

환자중에 양쪽 다리가 착색되있고, 부어있는 경우를 본적있는가? 

from wikipedia https://en.wikipedia.org/wiki/Chronic_venous_insufficiency

 

consultant 들이 많이 물어보는 질문이다 "What do you think?"

그럼 chornic venous insufficiency 라고 대답해주면 된다.   it is from elevated venous pressure / venous hypertension 

 

그럼 또 묻는다. "이유가 뭔거 같니?"

 

 

Pathophysiology 

-Inadequate muscle pump function

-incompetent venous valves (reflux)

-venous thrombosis, or nonthrombotic venous obstruction

It initiates a sequence of anatomic, physiologic, and histologic changes leading to vein dilation, skin changes, and/or skin ulceration. 

 

Risk factors 

-Advancing age

-female sex

-family history of venous disease

-ligamentous laxity (eg, hernia, flat feet)

-prolonged standing

-increased body mass index

-smoking

-lower extremity trauma

-prior venous thrombosis (ie, post-thrombotic)

-some hereditary conditions (eg, Klippel-Trenaunay syndrome)

-high estrogen states

-higher parity

 

Clinical features 

: pain, leg heaviness, aching, swelling, skin dryness, tightness, itching, irritation, and muscle cramps

: lipodermatosclerosis 

: Skins discolouration is caused by hemosiderin deposition from extravasated erythrocytes. 

from uptodate

 

Diagnosis 

Venous duplex ultrasound examination confirms the diagnosis demonstrating the presence of venous reflux

Most symptomatic patients should undergo venous duplex ultrasonography to evaluate the nature and extent of venous reflux, which impacts the choice of treatment.

Any combination of superficial, perforator or deep venous reflux, or deep venous obstruction can be present. 

 

Management 

-Compression therapy like compression stockings 

-local wound care

-leg elevation 

-ambulation 

 -Emollients to restore the skin barrier 

 

 

 

Reference 

-UptoDate