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Chronic Venous Insufficiency and Postphlebitic Syndrome

by James D. Douketis, MD

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). Causes of chronic venous insufficiency are disorders that result in venous hypertension, usually through venous damage or incompetence of venous valves, as occurs (for example) after DVT. Diagnosis is by history, physical examination, and duplex ultrasonography. Treatment is compression, wound care, and, rarely, surgery. Prevention requires adequate treatment of DVT and compression stockings.

Chronic venous insufficiency affects up to 5% of people in the US. Postphlebitic syndrome may affect one fifth to two thirds of patients with DVT, usually within 1 to 2 yr after acute DVT.

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