Symptoms of peripheral edema include swelling of the affected area(s), which causes the surrounding skin to "tighten." The swelling from peripheral edema is gravity-dependent (it will increase or decrease with changes in body position).
In the case of pulmonary edema, there is often no evidence of fluid retention or noticeable swelling on examination of the patient's extremities.
Lymphedema is the swelling of one or more of the legs and arms caused by poor function of the lymphatic system.
Read What Your Physician is Reading on Medscape Congestive Heart Failure and Pulmonary Edema »Congestive heart failure (CHF) is an imbalance in pump function in which the heart fails to adequately maintain the circulation of blood.
Venous insufficiency is a condition in which the veins do not efficiently return blood from the lower limbs back to the heart.
The superficial veins lie in the subcutaneous fatty layer of the body just beneath the skin and superficial to the deep fascia enveloping the body musculature.
The perforating veins penetrate the deep fascia and connect the superficial veins to the deep veins. The intramuscular sinusoidal veins are large, very thin walled, valveless veins within skeletal muscle. In systemic circulation oxygenated blood is pumped by the left ventricle through the arteries to the muscles and organs of the body, where its nutrients and gases are exchanged at capillaries, entering the veins filled with cellular waste and carbon dioxide.
The de-oxygenated blood is taken by veins to the right atrium of the heart, which transfers the blood to the right ventricle, where it is then pumped to the pulmonary arteries and eventually the lungs. In pulmonary circulation the pulmonary veins return oxygenated blood from the lungs to the left atrium, which empties into the left ventricle, completing the cycle of blood circulation. Phasic Flow: The breathing-related intra-abdominal pressure changes lead to respiratory fluctuation of venous flow with faster flow during expiration due to lower intraabdominal pressure (upward movement of diaphragm) and slower flow during inspiration due to higher intraabdominal pressure (downward movement of diaphragm). The muscle pump or the venous pump: The muscle pump mechanism is highly developed in the calf muscles. Clinical manifestations of venous insufficiency include various conditions such as telangiectasias, varicose veins, and axial incompetence. Lipodermatosclerosis: LDS or liposclerosis refers to a thickening in the tissues underneath the skin. Performing a Tourniquet test is necessary to determine the level of valvular incompetence in the superficial system and to ascertain whether deep venous system involvement is present. The patient should wait in a supine position with the limb elevated for at least one minute before starting to perform the Tourniquet test. If after removal of the below-knee tourniquet the lesser saphenous system fills, then presence of lesser saphenous incompetence is most likely. A Trendelenburg test determines the competency of the valves in communicating veins between the superficial and deep veins of the leg. The Trendelenburg test is often confused with Trendelenburg's sign, which is related to conditions affecting the hip and femur.
The Perthes test is a clinical test for assessing the patency of the deep femoral vein prior to varicose vein surgery.
This test is sometimes referred to as the Delbet-Mocquot test, named after French physicians Pierre Delbet and Pierre Mocquot.
The test in done by applying a tourniquet at the level of the saphenofemoral junction to occlude the superficial pathway, and then the patient is asked to move in situ. The examination is often done in the upright position, as this is the best way to evaluate valve function. MRI provides sagittal, coronal, and cross-sectional views and is able to detect acute occlusion. Thermography provides an infrared map of cutaneous temperature and can be used to help identify suferficial and perforating veins. Anti-inflammatory medication such as ibuprofen or aspirin can be used as part of treatment for superficial thrombophlebitis along with graduated compression hosiery – but there is a risk of intestinal bleeding. More aggresive thrombolytic therapy with injectable low molecular weight heparins (such as lovenox or arixtra) can also reduce fibrin formation and has been successfully clinically to reduce the signs and symptoms of venous insufficiency [8].
CHIVA is the acronym for Conservative and Hemodynamic cure of Incompetent Varicose veins in Ambulatory patients translated from the French cure Conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire[5] published in France in 1988. CHIVA relies on an hemodynamic impairment assessed by data and evidences depicted through Ultrasound dynamic venous investigations.


It generally consists in 1 to 4 small incisions under local anesthesia in order to disconnect the varicose veins from the abnormal flow due to valvular incompetence which dilates them.[6] The patient is dismissed the same day. Preserve the superficial venous capital for unpredictable but possible need for coronary or leg artery vital by-pass which increases with ageing. Consequences to be achieved properly, CHIVA method needs a comprehensive knowledge of both hemodynamics and Ultrasound venous investigation. Conventional surgery: Conventional surgery for varicose veins does relieve symptoms and has a role on the prevention of chronic venous ulceration. A commonly performed non-surgical treatment for varicose and "spider" leg veins is sclerotherapy.
A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux.[20] Complications of sclerotherapy are rare but can include blood clots and ulceration. Endovenous laser ablation (EVLA) is a relatively simple and quick technique which can be performed under a local anesthetic. The Australian Medical Services Advisory Committee (MSAC) in 2008 has determined that endovenous laser treatment for varicose veins "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and vein stripping for the treatment of varicose veins."[22] It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury and paraesthesia, post-operative infections and haematomas, appears to be greater after ligation and stripping than after EVLT".
Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency obliteration (AKA radiofrequency ablation) compared to open surgery.[24][25] Myers[26] wrote that open surgery for small saphenous vein reflux is obsolete.
Finding the right home remedies for pimples can be difficult, since there can be multiple causes for their appearance. For example, if a person is lying on their back (supine), the swelling will not appear in the legs, but will appear in the area around the sacrum. The principal veins in the legs are the great and lesser saphenous veins and their tributaries; in the arms they are the basilic and cephalic veins and their tributaries.
It is common in the extremities for there to be two or more veins accompanying a small to medium sized artery.
Those along the inner (medial) side of the lower leg play a major role in the pathogenesis of the postphlebitic leg. Flow in the arterial system is dependent on the pumping action of the heart and the elasticity and muscular activity of the arteries.
This pressure dependent flow pattern is transmitted through the upper leg veins into the major deep veins in the distal lower leg and into the major superficial veins (great and small saphenous veins) in the recumbent patient. Venous claudication may mimic arterial intermittent claudication, though it typically takes longer to subside after stopping exercise.
This maneuver empties the veins by reducing venous congestion in the superficial venous system. If the superficial veins of the calf segment fill, perforating vein incompetence is usually present. In following step, the above-knee tourniquet is removed to assess the competence of the Hunter's canal perforator.
The leg is raised above heart level until the veins become empty, then the leg is quickly lowered. In addition, the function of valves in each segment of the evaluated veins can be assessed by determining the direction of blood-flow using Doppler ultrasound. In extensive superficial thrombophlebitis, consideration should be given to anti-coagulation, thrombectomy or sclerotherapy of the involved vein.
It has phase II and III clinical trials that demonstrate its effectiveness as a fibrinolytic agent. According to this new concept, the clinical symptoms of venous insufficiency are not the cause but the consequence of various abnormalities of the venous system. For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5-60%. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready.[21] There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected.
Endovenous laser techniques employ an 810 nm-diode laser to heat the long or short saphenous vein (or major tributaries), inducing a combination of endothelial damage, focal coagulative necrosis, shrinkage of the vein and thrombotic occlusion. Myers said these veins should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%.
Changes of cutaneous microcirculation from elasto-compression in chronic venous insufficiency.


Department of Surgery and Radiology, Hospital of Varberg, Sweden Long saphenous vein saving surgery for varicose veins. Saphenofemoral junction incompetence treated by ultrasound-guided sclerotherapy, Dermatol Surg. But, most importantly, cut down on processed foods and fast foods, all of which are overflowing with salt.
The skin over the swollen area appears tight and shiny, and often when pressure is applied to the area with a finger, an indentation appears. Venous insufficiency is a condition in which the veins fail to return blood efficiently to the heart. In contrast, venous insufficiency may be refractory to treatment as in the severely damaged postthrombotic limb which manifests segmental occlusion in combination with universal venous reflux.
Over time, long standing stasis of blood leads to the deposition of hemosiderin, giving the skin a dark, speckled appearance.
At the end, if the superficial venous system remains empty, then the high thigh tourniquet is removed to detect saphenofemoral incompetence. Superficial veins of the leg normally empty into deep veins, however retrograde filling occurs when valves are incompetent, leading to varicose veins. Function of the proximal valves is evaluated during Valsalva maneuver in the recumbent patient and Doppler sampling in the common and superficial femoral veins during increased abdominal pressure.
For example,a varicose vein being overloaded, may be dilated not only because of valvular incompetence (the most frequent) but because of a venous block (thombosis) or arterio-venous fistula, and so the treatment has to be tailored according the hemodynamic feature. In comparison, radiofrequency ablation has been shown to control 80% of cases of small saphenous vein reflux at 4 years, said Myers. In Davy A and Stemmer R, editors: Phlebology '89, Montrouge, France, 1989, John Libbey Eurotext. Long-term edema causes pitting: When you press on the swollen area for a few seconds, you will notice an indentation in that area. Contractions of the calf muscles can produce a sufficient pressure to empty the sinusoids into the deep veins. If removing the ankle tourniquet fills the superficial venous system, presence of perforating vein incompetence is suspected. Continued swelling can cause skin ulcerations.Home Remedies for Ankle SwellingLift ankle so that the leg is straight in front of you on the sofa or on a chair.
The deep veins are affected with the similar compressing force due to a strong fascial structure. Symptoms include swelling of the legs and pain in the extremities such as a dull aching, heaviness, or cramping. This occurs as a result of gravity working against an already ineffective blood return system.
Place an ice pack, or ice in a plastic bag wrapped in a clean dish towel on the raised ankle.Apply a cold pack to control the swelling, such as crushed ice in a plastic bag, a cold gel pack, or a bag of frozen peas or green beans. Patients with severe arterial insufficiency, on the other hand, may have relatively pale skin as a result of under perfusion.
When their legs are placed in a dependent position, gravity enhances arterial inflow and the skin may become more red as maximally dilated arterioles attempt to bring blood to otherwise starved tissues. In cases of severe ischemia, the affected areas (usually involving the most distal aspect of the foot), can appear whitish or mottled, giving the leg a marbleized appearance. I use two 12 x 18 in gel packs, so one is always in the freezer.Vinegar To soothe tendinitis, sprains, strains, and general foot aches, alternate hot and cold vinegar wraps. Cucumber will absorb the fluid and speed recovery.Lecithin seedsLecithin seeds are another effective home remedy for the treatment of Swelling of Feet during Pregnancy. Repeat this entire sequence three times.Vitamin E-rich foodIt is also found that Vitamin E-rich food is good for patients suffering from Swelling of Feet during Pregnancy. Some of the Vitamin E-rich food is spinach, almond oil, sweet potato, sunflower seeds, and wheat germs.ExerciseSit on the carpet and stretch your leg in the front, rotate your leg 10-15 times in a clockwise direction and then in the same way rotate in the anti-clock wise direction for 10-15 times.



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