Chronic Venous Insufficiency
Chronic Venous Insufficiency (CVI) refers to insufficient venous return from the legs back to central circulation. CVI is a significant health issue in the United States and other Western countries. As the disease process progresses it leads to incompetence of venous valve and muscle pump activity and causes blood and fluid to pool in the legs and feet.
During early stages, the swelling decreases with leg elevation. Without treatment CVI will progress.
Advanced stages of CVI are associated with chronic swelling in the lower legs, increased lymphatic activity to clear the extra fluid leading to insufficiency of the lymphatic system, damage to the venous and lymphatic systems, red and brown discoloration (Rusty Leg Syndrome or hemosiderin stains), development of fibrotic tissue, swelling that does not recede, and ulcers on the legs.
Dr. Margaret Latham is trained in all the components of CDT as well as the treatment of vascular wounds that may be present. She provides client education throughout the process so that clients can independently manage their condition and refers clients to physician services as needed or to manage other conditions. Dr. Margaret can also assist clients in selecting and fitting the most appropriate compression garments for the management of CVI in the early stages.
The Stages of CVI
0. Usually not associated with leg swelling but light compression during the day can be helpful.
I. Swelling develops at the end of the day but usually disappears overnight or with elevation of the legs. Compression garments (NOT TED hose) are indicated to manage Stage I CVI and prevent or limit progression. Complete Decongestive Therapy (CDT) is not needed at this stage.
II. Damage has now occurred to the venous and lymphatic systems. Plasma and blood cells escape into the interstitial tissues (between the skin and muscle fascia) causing hemorrhages in the skin and discoloration most notable at the ankles. Swelling no longer recedes at night or with elevation. Fibrotic tissue begins to develop. CDT is now an appropriate treatment.
III. The disease has now progressed to include all the symptoms of Stage II as well as the development of venous ulcers. The swelling is now so great that the skin is too far away from the blood capillaries to receive nutrients or dispose of waste products. Fungal infections of the skin are also common at this stage. Fibrotic tissue increases. CDT is also the appropriate treatment for stage III CVI but may have more limited results due the severity of the progression.
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