DVT is the primary cause of pulmonary embolism. DVT results

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Chronic Venous Insufficiency and Postphlebitic
Syndrome
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• Chronic venous insufficiency is impaired venous
  return, sometimes causing lower extremity
  discomfort, edema, and skin changes.
• Postphlebitic (postthrombotic) syndrome is
  symptomatic chronic venous insufficiency after
  deep venous thrombosis (DVT).

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Etiology

• Chronic venous insufficiency occurs when
• - venous obstruction (eg, in DVT),
• - venous valvular insufficiency,
• - decreased contraction of muscles surrounding
  the veins (eg, due to immobility)
• - decrease forward venous flow and increase
  venous pressure (venous hypertension).

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Symptoms and Signs

• chronic venous insufficiency may not cause any
  symptoms but always causes signs
• postphlebitic syndrome always causes symptoms

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• Symptoms include
• - a sense of fullness,
• heaviness,
• aching,
• cramps,
• pain,
• tiredness,
• paresthesias in the legs
• these symptoms worsen with standing or walking
  and are relieved by rest and elevation.

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• Signs
• - Venous stasis dermatitis
• - Venous stasis ulcers
• - Leg edema

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• Diagnosis
• - Clinical diagnosis
• - Ultrasonography to exclude DVT

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• Prevention
• Primary prevention
• - adequate anticoagulation after DVT
• - use of compression stockings for up to 2 yr
  after DVT or lower extremity venous trauma.
• - Lifestyle changes (eg, weight loss, regular
  exercise, reduction of dietary NaCl) can decrease
  risk by decreasing lower extremity venous pressure

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• Treatment
• Elevation
• Compression
• Topical treatments

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• Deep Venous Thrombosis
• (DVT)

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Deep Venous Thrombosis (DVT)

• is clotting of blood in a deep vein of an
  extremity (usually calf or thigh) or the pelvis.
• DVT is the primary cause of pulmonary embolism.

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• DVT results from conditions that
• - impair venous return,
• - lead to endothelial injury or
  dysfunction,
• - cause hypercoagulability

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• Complications
• - chronic venous insufficiency
• - postphlebitic syndrome, as well as PE
• phlegmasia alba dolens
• phlegmasia cerulea dolens

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• symptoms and signs
• vague aching pain, tenderness along the
  distribution of the veins, edema, erythema ?are
  nonspecific
• Calf discomfort elicited by ankle
  dorsiflexion with the knee extended (Homans'
  sign) occasionally occurs with distal leg DVT but
  is neither sensitive nor specific

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• If PE occurs, symptoms may include shortness of
  breath and pleuritic chest pain

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• Diagnosis
• - Ultrasonography
• - D-dimer testing ( product of fibrinolysis )
  
• - Venography

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• Treatment
• Anticoagulation
• ( Treatment is aimed primarily at PE prevention
  )
• - Low mol wt heparins
• - Unfractionated heparins
• - Fondaparinux
• - Warfarin

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• Inferior vena cava filter (IVCF)
• Thrombolytic (fibrinolytic) drugs
• Surgery

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• Prevention
• - Prevention of immobility
• - Assessment of risk
• - Anticoagulation
• - Intermittent pneumatic compression
• - Inferior vena cava filter