Chronic Venous Stasis
What is Chronic Venous Stasis?
This is the most advance presentation of venous disease. Patients complain of leg swelling, have pigmentation and induration of the tissues under the skin and develop ulcerations.
Patients present with leg swelling, pigmentation, induration of the tissues under the skin and ulceration. This pathology may be the result of previous episodes of phlebitis in the deep veins (DVT) or it may be due to failure of valves of the superficial, deep or perforating venous system to close properly.
In these advances cases of chronic venous insufficiency it is very important to determine what veins are defective, so that the treatment can be directed to their specific repair. This study is done with duplex ultrasound, phletismography and in some case venography.
Available Treatments for Chronic Venous Stasis
This is a very important component of the treatment of chronic venous stasis. The purpose is to assist the system in pumping of blood from the legs to the heart reducing swelling.
Ablation of the Saphenous Veins
Reflux of the superficial veins of the legs (saphenous veins) is an important component of the pathogenesis of chronic venous stasis. If present, they can be ablated with laser, improving the function of the circulation of the affected limb.
Ablation of Perforating Veins
As with saphenous veins, if perforating veins are abnormal, they can be ablated with laser energy.
Repair of Valves of the Deep Venous System
In cases of severe reflux of the deep veins with valves that do not function, they can be fixed with delicate surgery (valvuloplasty).
Balloon Angioplasty and Stenting of Occluded or Narrowed Veins
Vessels that are closed or narrowed can be opened with minimally invasive procedures. A catheter with a balloon in its tip is passed through the vessel, and the balloon is inflated in the affected area, stretching the vessel. If the “balloon angioplasty” does not return the problem completely to normality, a stent can be deployed and this will keep the vessel open.
When ulcers are present, treatment will consist of:
Weekly Application of Unna Boot
This treatment consists of applying in the affected leg a bandage impregnated in Zing Oxide. This bandage is changes at weekly intervals, until the ulcer is healed.
Occasionally, Skin Grafting may be necessary.
If the ulcer is too large or healing is very slow, a thin slice of skin taken from the same patient’s body is placed over the ulcer. This skin graft is simple and very successful.