Venous Disorders
The venous system, which returns the oxygen-depleted blood to the heart via a network of increasingly larger blood vessels, often must work against gravity, especially in returning blood from the lower part of the body. Coordinated muscular contractions and, in medium-size veins, a system of one-way valves help keep the blood flowing in the right direction. But these vessels are not aided by the pumping action of the heart or the elastic tension that enables the arteries to function. Thus, many of the disorders arising in the venous system are related to a breakdown in their ability to maintain blood flow.
The venous system, which returns the oxygen-depleted blood to the heart via a network of increasingly larger blood vessels, often must work against gravity, especially in returning blood from the lower part of the body. Coordinated muscular contractions and, in medium-size veins, a system of one-way valves help keep the blood flowing in the right direction. But these vessels are not aided by the pumping action of the heart or the elastic tension that enables the arteries to function. Thus, many of the disorders arising in the venous system are related to a breakdown in their ability to maintain blood flow.
What are Venous Ulcers?
About 70% of people with ulcers have this type which are the result of venous disease. They tend to occur in the so-called Gaiter Area - halfway up the calf and down to just below the ankle. Veins drain blood from the feet & lower leg uphill to the heart. This blood has to be re-cycled through the heart and lungs to get rid of waste products and pick up oxygen. This system is important to keep the legs and feet healthy. Two mechanisms assist in this uphill flow of blood.
The Calf Muscle Pump: Muscles used for walking and exercise act as a pump by contracting and relaxing and helping to force blood uphill towards the heart.
Valves: The veins in the legs have one-way valves which prevent blood flowing back downhill.
If the valves do not work properly and do not close in the normal way blood will flow back downhill and cause congestion. This may lead to legs which are swollen and tender to touch. The skin may feel dry and itchy and have mottled brown or black staining, and may appear crusty in the gaiter area. The legs may become painful when sitting down. Venous ulcers can develop in this type of leg.
Causes of Venous Ulcers
The following conditions indicate an increased risk for venous ulceration:
~ A history of deep vein thrombosis, which can damage vein valves
~ A family history of venous disease
~ Lower-extremity edema, which increases the risk of tissue breakdown.
Certain conditions are also linked with the development of venous leg ulcers including:
~ High Blood Pressure
~ Phlebitis
~ Varicose Veins
~ Fractures or Injuries
~ Multiple Pregnancies
~ Previous Surgery
~ Sitting or standing for long periods
~ Obesity
Treatment of Venous Ulcers?
Treatment goals include local wound care and correction of the underlying problem. Oral antibiotics are prescribed if there is infection and topical steroids are sometimes used for the surrounding skin irritation. The leg may be wrapped in a boot-like dressing that offers both medication soothing to the skin and compression. There are other dressings that may speed wound healing. The cornerstone of therapy for venous ulcers is the use of compression in the form of gradient compression therapy. There are new medications that contain growth factors which are not widely used but may hold hope for the future.
About 70% of people with ulcers have this type which are the result of venous disease. They tend to occur in the so-called Gaiter Area - halfway up the calf and down to just below the ankle. Veins drain blood from the feet & lower leg uphill to the heart. This blood has to be re-cycled through the heart and lungs to get rid of waste products and pick up oxygen. This system is important to keep the legs and feet healthy. Two mechanisms assist in this uphill flow of blood.
The Calf Muscle Pump: Muscles used for walking and exercise act as a pump by contracting and relaxing and helping to force blood uphill towards the heart.
Valves: The veins in the legs have one-way valves which prevent blood flowing back downhill.
If the valves do not work properly and do not close in the normal way blood will flow back downhill and cause congestion. This may lead to legs which are swollen and tender to touch. The skin may feel dry and itchy and have mottled brown or black staining, and may appear crusty in the gaiter area. The legs may become painful when sitting down. Venous ulcers can develop in this type of leg.
Causes of Venous Ulcers
The following conditions indicate an increased risk for venous ulceration:
~ A history of deep vein thrombosis, which can damage vein valves
~ A family history of venous disease
~ Lower-extremity edema, which increases the risk of tissue breakdown.
Certain conditions are also linked with the development of venous leg ulcers including:
~ High Blood Pressure
~ Phlebitis
~ Varicose Veins
~ Fractures or Injuries
~ Multiple Pregnancies
~ Previous Surgery
~ Sitting or standing for long periods
~ Obesity
Treatment of Venous Ulcers?
Treatment goals include local wound care and correction of the underlying problem. Oral antibiotics are prescribed if there is infection and topical steroids are sometimes used for the surrounding skin irritation. The leg may be wrapped in a boot-like dressing that offers both medication soothing to the skin and compression. There are other dressings that may speed wound healing. The cornerstone of therapy for venous ulcers is the use of compression in the form of gradient compression therapy. There are new medications that contain growth factors which are not widely used but may hold hope for the future.
Venous Insufficiency
Chronic venous insufficiency (CVI) results from failure of the valves in deep or superficial veins. Venous anatomy in the legs is uniquely designed to allow blood to flow against the force of gravity. One-way valves in the veins close at the end of each pulsitile burst of blood upward toward the heart, ensuring unidirectional blood flow. A damaged valve with bi-directional blood flow can allow blood to flow back from the deep venous system into the superficial venous system.
Over time, the weight of this column of blood causes fluid and protein to exude into surrounding tissues where it leaks and pools in the legs and feet. Chronic venous insufficiency can cause discoloration of the skin of the ankles and may lead to tissue breakdown, and ulceration. Venous ulcers are most commonly found around the ankle. They have irregular borders and are more likely to have copious drainage than other ulcer types.
Causes of Venous Insufficiency
The following conditions indicate an increased risk for venous ulceration:
~ A history of deep vein thrombosis, which can damage vein valves
~ A family history of venous disease
~ Lower-extremity edema, which increases the risk of tissue breakdown.
Treatment of Venous Insufficiency
Gradient compression stockings help prevent the veins in your legs from becoming overly filled with blood (congested). Veins that are congested with blood make your legs feel heavy. They may ache and fatigue easily. These stockings act to prevent leg swelling by counteracting pressures inside the leg and promoting blood flow back to the heart rather than allowing blood to pool in the legs. Compression squeezes the legs. This can be achieved by special bandaging, gradient compression stockings, or special air pumps.
Venous Insuffienciency is often accompanied by edema and decreased oxygen and nutrient composites in tissue. Since lymph drainage can be augmented by external pressure, proximal venous flow also benefits from external compression, the use of pneumatic compression devices to treat venous insufficiency has proven highly successful. Pumping promotes cutaneous circulation which increases the oxygen content of tissues.
Treatment
Stage 1:
Gradient elastic stockings Skin care
Stage 2:
Gradient elastic stockings Skin care Topical steroids for dermatitis Surgical consultation
Stage 3:
Gradient elastic stockings
Ulcer care:
(a)Antiseptic solution
(b)Bio-occlusive dressings Pneumatic, gradient compression pump therapy
Chronic venous insufficiency (CVI) results from failure of the valves in deep or superficial veins. Venous anatomy in the legs is uniquely designed to allow blood to flow against the force of gravity. One-way valves in the veins close at the end of each pulsitile burst of blood upward toward the heart, ensuring unidirectional blood flow. A damaged valve with bi-directional blood flow can allow blood to flow back from the deep venous system into the superficial venous system.
Over time, the weight of this column of blood causes fluid and protein to exude into surrounding tissues where it leaks and pools in the legs and feet. Chronic venous insufficiency can cause discoloration of the skin of the ankles and may lead to tissue breakdown, and ulceration. Venous ulcers are most commonly found around the ankle. They have irregular borders and are more likely to have copious drainage than other ulcer types.
Causes of Venous Insufficiency
The following conditions indicate an increased risk for venous ulceration:
~ A history of deep vein thrombosis, which can damage vein valves
~ A family history of venous disease
~ Lower-extremity edema, which increases the risk of tissue breakdown.
Treatment of Venous Insufficiency
Gradient compression stockings help prevent the veins in your legs from becoming overly filled with blood (congested). Veins that are congested with blood make your legs feel heavy. They may ache and fatigue easily. These stockings act to prevent leg swelling by counteracting pressures inside the leg and promoting blood flow back to the heart rather than allowing blood to pool in the legs. Compression squeezes the legs. This can be achieved by special bandaging, gradient compression stockings, or special air pumps.
Venous Insuffienciency is often accompanied by edema and decreased oxygen and nutrient composites in tissue. Since lymph drainage can be augmented by external pressure, proximal venous flow also benefits from external compression, the use of pneumatic compression devices to treat venous insufficiency has proven highly successful. Pumping promotes cutaneous circulation which increases the oxygen content of tissues.
Treatment
Stage 1:
Gradient elastic stockings Skin care
Stage 2:
Gradient elastic stockings Skin care Topical steroids for dermatitis Surgical consultation
Stage 3:
Gradient elastic stockings
Ulcer care:
(a)Antiseptic solution
(b)Bio-occlusive dressings Pneumatic, gradient compression pump therapy
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