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All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. 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. Chronic venous insufficiency can pose a more serious result if not given proper medical attention. Doppler studies are done in order to know the blockage as well as the extent of the damaged valves.
When ulceration is found, then surgical management must be done in order to prevent further skin breakdown. Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center.
Turner syndrome also called as Monsomy X is a genetic disorder in which the female child misses one pair of normal X chromosomes. Normally every child inherits 23 pairs of chromosomes out of which two are sex chromosomes which determine the gender of the child.
The symptoms of this disease are swollen hands, webbed neck and wide feet are found on the infants.
The leg muscles normally contract and compress blood vessels to promote blood flow with walking or running. Warm temperatures cause the blood vessels to expand, making it easier for fluid to cross into surrounding tissues. Certain drugs, such as steroids, hormone replacements, nonsteroidal anti-inflammatory drugs (NSAIDs), and some blood pressure medications may affect how fast fluid leaves blood vessels. The changing levels of hormones affect the rate at which fluid enters and leaves the tissues. When the heart is unable to maintain adequate blood flow throughout the circulatory system, the excess fluid pressure within the blood vessels can cause shifts into the interstitial spaces. These conditions can change the concentration of protein in the blood, affecting fluid movement in and out of the tissues. Protein levels are decreased in the blood, and in an effort to maintain a balance of concentrations, fluid shifts out of the vessels and causes edema in tissue spaces. Varicose veins, or veins whose walls or valves are weak, can allow blood to pool in the legs.


Abnormal masses can compress leg vessels and lymph channels, affecting the rate of fluid movement. In general, weight gain, puffy eyelids, and swelling of the legs may occur as a result of excess fluid volume. Placing the legs at least 12 in (30.5 cm) above the level of the heart for 10-15 minutes, three to four times a day, stimulates excess fluid re-entry into the circulatory system.
Elastic stockings, available at most medical supply or drug stores, will compress the leg vessels, promoting circulation and decreasing pooling of fluid due to gravity. Massaging the body part can help to stimulate the release of excess fluids, but should be avoided if the patient has blood clots in the veins.
Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content. 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.
However, the symptoms exceeded more than two weeks it can already classified as chronic venous insufficiency.
It can eventually lead to ulcerations or skin breakage on the skin making the person prone infections. These valves help in preventing the backflow of the blood while it is being brought back to the heart.
A colour-flow study is done in order to separate the veins that are doing well from those that are blocked or damaged.
Stretching from time to time can also help in the circulation of the blood on the lower extremities.
If the child is female, it would have two XX chromosomes and if it is a male it would have XY chromosome.
In developed girls, there will be incomplete puberty, small breasts and absence of pubic hair. Since they are infertile, they can either adopt a child or have a donor egg implanted on the uterus for having a baby. The fluid, which contains oxygen and nutrients needed by the cells, moves from the walls of the blood vessels into the body's tissues. When these muscles are not used, blood can collect in the veins, making it difficult for fluid to move from tissues back into the vessels. Digoxin is a digitalis preparation that is sometimes needed to decrease heart rate and increase the strength of the heart's contractions.
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. The terms postphlebitic syndrome and postthrombotic syndrome may also point out the same description.
A Venogram is also used in order to assess the veins that are not fit for good circulation. However in turner syndrome children, the female child will have only one X chromosome, missing the other one. Some doctors try giving estrogen therapy for girls to induce the growth of hairs and development of breasts.


After its nutrients are used up, fluid moves back into the blood vessels and returns to the heart. Lymphedema may also occur after cancer treatments, when the lymph system is impaired by surgery, radiation, or chemotherapy.
Hand and neck veins may be observed as fuller.DiagnosisEdema is a sign of an underlying problem, rather than a disease unto itself. 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. The lymphatic system (a network of channels in the body that carry lymph, a colorless fluid containing white blood cells to fight infection) also absorbs and transports this fluid. Right-sided heart failure can cause pitting edema, a swelling in the tissue under the skin of the lower legs and feet.
Consideration of adequate protein intake is also made.For patients with lymphedema, a combination of therapies may prove effective. 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. An infrared light is passed through the lower extremities during leg exercise, the slower the capillary refill the more it indicates incompetent veins on the legs. In edema, either too much fluid moves from the blood vessels into the tissues, or not enough fluid moves from the tissues back into the blood vessels.
Patient history and presenting symptoms, along with laboratory blood studies, if indicated, assist the health professional in determining the cause of the edema.TreatmentTreatment of edema is based on the cause. Combined decongestive therapy includes the use of manual lymph drainage (MLD), compression bandaging, garments and pumps, and physical therapy. Patients with severe arterial insufficiency, on the other hand, may have relatively pale skin as a result of under perfusion. Taking a look at the lifestyle of patients can also be considered as a key factor in determining the cause of chronic venous insufficiency.
MLD involves the use of light massage of the subcutaneous tissue where the lymph vessels predominate. 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.
Sedentary lifestyle can ultimately result in stasis of the muscles of the lower legs to contract in order to bring back the blood to the heart. Massage begins in an area of the body trunk where there is normal lymph function and proceeds to areas of lymphatic insufficiency, in an effort to stimulate new drainage tract development. 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.
Physical therapy is aimed at strengthening the affected limb and increasing joint mobility.Alternative treatmentDietary changes, in addition to cutting back the amount of sodium eaten, may also help reduce edema. Foods that worsen edema, such as alcohol, caffeine, sugar, dairy products, soy sauce, animal protein, chocolate, olives, and pickles, should be avoided. One of the best herbs for this purpose is dandelion (Taraxacum mongolicum), since, in addition to its diuretic action, it is a rich source of potassium. This accumulation can occur in the cells (cellular edema), in the intercellular spaces within tissues (interstitial edema), or in potential spaces within the body. Edema may also be classified by location, such as pulmonary edema or brain edema; types found in certain locations have specific names, such as ascites (peritoneal cavity), hydrothorax (pleural cavity), or hydropericardium (pericardial sac).
Classification by location does not indicate whether the edema is cellular or interstitial or occupies a potential space (for example, brain edema may be either cellular or interstitial). Edema can be caused by a variety of factors, including conditions that affect osmotic pressure, such as hypotonic fluid overload, which allows the movement of water into the intracellular space, or hypoproteinemia, which decreases the concentration of plasma proteins and permits the passage of fluid out of the blood vessels into the tissue spaces. With trauma, increased capillary permeability and dilation cause leaking into tissue space. Initially clear, exudate in the tissue space becomes more viscous with an increase in plasma protein. This may occur because of decreased osmolality of the fluid surrounding the cells, as in hypotonic fluid overload, or increased osmolality of the intracellular fluid, as in conditions that decrease the activity of the sodium pump of the cell membrane, allowing the concentration of sodium ions within the cell to increase.cerebral edema swelling of the brain caused by the accumulation of fluid in the brain substance.
It may result from head injury, stroke, infection, hypoxia, brain tumors, obstructive hydrocephalus, and lead encephalopathy; it may also be caused by disturbances in fluid and electrolyte balance that accompany hemodialysis and diabetic ketoacidosis. The most common type is vasogenic edema, which may result from increased capillary pressure or from increased capillary permeability caused by trauma to the capillary walls. Because the brain is enclosed in the solid vault of the skull, edema compresses the blood vessels, decreasing the blood flow and causing ischemia and hypoxia, which in turn result in further edema. See also nonpitting edema.pulmonary edema diffuse extravascular accumulation of fluid in the tissues and air spaces of the lung due to changes in hydrostatic forces in the capillaries or to increased capillary permeability. It is most often symptomatic of left ventricular heart failure, but can also be a complication of mitral stenosis, aortic stenosis, altitude sickness, acute hypertension, volume overload during intravenous therapy, or reduced serum oncotic pressure, as in patients who have nephrosis, cirrhosis, or hypoalbuminemia.During the initial stage of pulmonary edema, patients may complain of restlessness and anxiety and the feeling that they are getting a common cold.
As fluid continues to fill the pulmonary interstitial spaces the dyspnea becomes more acute, respirations increase in rate, and there is audible wheezing. Eventually, if the condition persists, the patient becomes less responsive to stimuli as levels of consciousness decrease. In some patients these phases are telescoped as the pulmonary edema develops rapidly and the final stages of respiratory insufficiency are evident in a very short period of time.Treatment is aimed at enhancing gas exchange, reducing fluid overload, and strengthening and slowing the heart beat.
To accomplish these goals the patient is often given oxygen by mask or through mechanically assisted ventilation.
Drug therapy includes diuretics to remove excess alveolar fluid and morphine to relieve anxiety and reduce the effort of breathing. At the gross level, used to describe the physical sign commonly likened to swelling or increased girth that often accompanies the accumulation of fluid in a body part, most often a limb.
See Angioneurotic edema, Brawny edema, Cerebral edema, Cyclic edema, Cytotoxic edema, Flash pulmonary edema, Hereditary angioneurotic edema, High-altitude cerebral edema, High-altitude pulmonary edema, Leukoedema, Macular edema, Malignant edema, Pedal edema, Pseudopapillaedema, Pulmonary edema. It is a major cause of visual loss in diabetics, and is related to poor control of blood glucose.
It may result from improper use of the voice, excessive use of tobacco or alcohol, chemical fumes, or viral, bacterial, or fungal infections. Clinically, the patient often presents with hoarseness or, in severe cases, with respiratory distress and stridor.
See: epiglottitisSymptomsInitially, hoarseness and, later, complete aphonia characterize this condition.




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