Overview of Venous Disorders
Venous disorders are among the most common conditions in the Western world. To understand the various venous disorders, it is important to understand the normal anatomy. Venous disorders can be divided into acute and chronic. Acute venous disorders are entirely thrombotic. The physiology of the acute thrombotic events can be ascribed to Virchow’s triad: hypercoagulability, hemodynamic changes (venous stasis), and endothelial injury/dysfunction. Examples are superficial thrombophlebitis, acute deep venous thrombosis, acute axillary-subclavian venous thrombosis, and portal vein system thrombosis. Novel therapeutic strategies for lower extremity acute vein thrombosis, such as catheter-directed thrombolysis, may be associated with a reduction of post-thrombotic syndrome risk. Chronic venous disorders are dominated by reflux through incompetent valves. It is thought that the development of all the clinical manifestations of chronic venous insufficiency (CVI) can be ascribed to a blood flow-driven inflammatory process. All the clinical manifestations of primary and secondary CVI may be conducted by this basic pathogenic mechanism. Telangiectasias and reticular varicosities are to be considered miniature varicose veins. Skin changes, such as atrophie blanche, lipodermatosclerosis, and venous ulcers, are to be considered advanced manifestations and therefore part of the pathologic spectrum of CVI. Thermal and chemical ablations for axial reflux have almost completely replaced high ligation and stripping of the great saphenous vein and short saphenous vein. In patients with post-thrombotic syndrome, iliac vein recanalization, angioplasty, and stenting have been shown to aid time to ulcer healing.
