Clinical diagnosis for both CVI and DVT start with a thorough physical examination, patient history, and an assessment of risk factors. CVI presents with pain, edema, skin changes, and ulcerations (Eberhardt & Raffetto, 2014). Noninvasive and invasive testing may be necessary to help diagnose CVI; however invasive testing should only be used if assessing severity and need for surgical intervention (Eberhardt & Raffetto, 2014). Treatment begins conservatively and advances as needed or depending on the patient’s clinical classification (Alguire & Scovell, 2018). Noninvasive treatment starts with leg elevation, using compression stockings, and exercise, whereas invasive management includes endovenous ablation, sclerotherapy, conservative vein resection, and vein stripping (Brashers, 2017). However,
5 ablation therapies are contraindicated in individuals with congenital abnormalities such as Klippel-Trenaunay Syndrome (Alguire & Scovell, 2018). DVT can present as asymptomatic, and often difficult to detect. D-dimer assay and ultrasonography are used to diagnose DVT (Brashers, 2017; Darwood & Smith, 2013). Typical symptoms of a DVT are calf pain and tenderness, fever, persistent tachycardia, and edema (Darwood & Smith, 2013). Treatment begins immediately with anticoagulation therapy for at least three months but can be extended if necessary. Heparin, warfarin, and oral anticoagulation medication such as factor Xa inhibitors are prescribed based on bleeding risks, patient comorbidities, preferences, cost, and convenience (Lip & Hull, 2018). Anticoagulation therapy is not altered due to genetic disorders for hypercoagulability (Lip & Hull, 2018). Thrombolysis and inferior vena cava filters are recommended for select patients (Darwood & Smith, 2013). Conclusion CVI and DVT are common medical conditions associated with high medical costs, mortality, and morbidity. A comprehensive understanding of the pathophysiology, signs, symptoms, proper diagnosis and treatment is essential for clinicians. Assessing patient risk factors can guide preventative measures to decrease the occurrence of CVI and DVT.
Chronic Venous Insufficiency (CVI) Epidemiology Age Sex Genetic Factors Obesity Injury Pregnancy Prolonged standing Crossing legs while sitting Pathophysiology Increased venous pressure Venous stasis Valvular dysfunction Venous reflux Tissue hypoxia Muscle pump malfunction Clinical Presentation Pain to lower leg Edema to lower extremities Feet and ankle hyperpigmentation Venous stasis ulcer Diagnosis Physical examination
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- Fall '17
- keisha lovence
- Venous insufficiency