Venous insufficiency (Varicose Veins, Thrombophlebitis)

Diagnosis
H&P

Treatment
-Leg elevation,
-Compression stockings. Will try 20-30 mmHg which works for most patients.
-Aspirin or NSAIDs and topical anti-inflammatory gels.
-Will try treatment for 6 months, if no significant improvement, will refer to vascular surgery for ablation or laser treatment.

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**Many insurance companies require documentation of compression of 30 mmHg or more for 3-6 months before approving surgical treatment.

-Elastic Compression stockings may be used with or without intermittent pneumatic compression

Cause of Varicose Veins

The ‘musculovenous pump’ of the lower extremities doesn’t pump blood back to the heart as it should. There is a retrograde flow and blood backs up.  A major cause of this is venous valvular incompetence. The leaflets of the venous valves don’t close properly. Repeated vein injury is a common reason why valves don’t work well. Incompetent values result lead to varicose veins (with or without symptoms) and thrombophlebitis (inflamed superficial and/or deep vein inflammation due to a blood clot).

References