Abstract | December 19, 2022
Venous Insufficiency
Learning Objectives
- Discuss importance of provider knowledge of venous insufficiency work-up and treatment.
- Describe symptoms associated with venous insufficiency.
- Demonstrate an understanding of diagnostic modalities associated with venous insufficiency diagnosis.
Introduction: Venous insufficiency is a common disease that affects millions of patients in the US, so it is important that providers are knowledgeable regarding its workup and treatment and that vascular surgery is consulted early on. Caused by dysfunctional valves, genetic factors, stenosis of veins, deep vein thrombosis, and more, venous insufficiency decreases blood flow to the heart as blood pools in the legs. This results in symptoms such as leg discomfort, burning, pain, numbness, and more.
Case Presentation: A 74-year-old female with a history of limb swelling and chronic vertigo presented to the vascular surgery clinic with bilateral lower extremity heaviness, achiness, cramping and swelling, onset six years ago, that has progressively gotten worse. Physical exam findings showed localized swelling, pitting edema, and changes in skin color of the lower legs. Results of the ankle brachial indexes and arterial doppler pulses showed that arterial disease was unlikely the cause of this patient’s symptoms. A venous reflux duplex ultrasound of the lower extremity was performed, demonstrating increased venous reflux bilaterally of the superficial femoral veins and common femoral veins.
Final/Working Diagnosis: The patient’s symptoms and venous reflux were indicative of chronic peripheral venous insufficiency.
Management/Outcome: A left venogram was performed at the outpatient catheter lab. Venous access was achieved via the left femoral vein and IV contrast was used to capture the venous stenosis of the iliac and femoral veins on fluorogram. An intravenous ultrasound measured the diameter of the veins to determine the percentage of venous stenosis, showing greater than 50% stenosis of the external iliac and common femoral veins, thus qualifying the patient for intervention via stent placement. Two stents were deployed and final venogram and IV ultrasound were completed to ensure proper placement of the stent and graft patency.
The patient was sent home later that day with instructions to take aspirin and apixaban daily for three months to decrease risk of blood clots. The patient followed up two weeks later, and will have another ultrasound completed three months post stent placement to determine if her symptoms have improved and to recheck graft patency.
References:
- https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi
- https://www.ncbi.nlm.nih.gov/books/NBK430975/
