Lower deep vein disease

Deep venous insufficiency may manifest as limb edema, chronic leg pain, stasis dermatitis, or ulceration, and the symptoms may be chronically disabling. Initial therapy is directed at ulcer healing and control of symptoms with wound care and compression. Once conservative measures have been instituted, the next step may be evaluation for any surgically correctable contributors to the symptomatology. Although valvular dysfunction and consequent venous reflux are a major cause of the venous hypertension that underlies the clinical manifestations of chronic venous insufficiency (CVI), recent studies suggest that iliac venous outflow obstruction plays a more important role in the pathogenesis of CVI than previously estimated. Any combination of superficial, perforator, and/or deep venous reflux can result in various stages of CVI, but when multiple segments of venous system are affected, the manifestations of CVI increase in severity. The combination of reflux and obstruction produces the highest levels of venous hypertension and the most severe clinical symptoms. This chapter discusses iliocaval vein obstructions and pelvic venous congestion.