Venous Insufficiency and Venous Ulcers


As functional venous valves are required to provide for efficient blood return from the lower extremities, CVI often occurs in the veins of the legs. Itching (pruritis) is sometimes a symptom, along with hyperpigmentation of the legs. Symptoms of CVI include phlebetic lymphedema and chronic swelling of the legs and ankles. The skin may react with varicose eczema, local inflammation, discoloration, thickening, and an increased risk of ulcers and cellulitis. The condition has been known since ancient times and Hippocrates used bandaging to treat it. It is better described as chronic peripheral venous insufficiency.

Venous valve incompetence is treated conservatively with manual compression lymphatic massage therapy, skin lubrication, a sequential compression pump, ankle pump, compression stockings, blood pressure medicine, frequent periods of rest elevating the legs above the heart level and using a 7-inch bed wedge during sleep. Surgical treatments include the old Linton procedures and the newer subfascial endoscopic perforator vein surgery. Some experimental valve repair or valve transposition procedures, as well as some hemodynamic surgeries, are being pursued. This whole field of medicine while ancient is still filled with complications e.g. Sometimes an artery can strangulate a vein or sometimes an arteriovenous fistula (an abnormal connection or passageway between an artery and a vein) may be causing the apparent poor venous return.

Patients are often encouraged to walk while wearing the prescribed medical stockings and to sleep in a 6 degree Trendelenburg position.[citation needed] Obese or pregnant patients might be advised by their physicians to forgo the tilted bed.

Surprisingly, leech therapy and maggot debridement, long ago abandoned by medicine, can actually be a beneficial treatment.[citation needed] The leeches draw out the excess venous blood that has C02 and metabolic wastes in a measured amount with little danger of dropping the blood volume. The maggots only eat dead flesh.[citation needed] Maggot debridement, actually is more thorough than surgical scraping. The FDA has approved maggot debridement. The maggots are raised in a sterile environment and encased in a mesh so they can eat the dead flesh and not crawl around.