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Chronic Venous Insufficiency



General Considerations

  • Most often occurs in veins of the legs
  • Retrograde flow of blood in veins
  • Most often due to incompetence of the valves in the lower pressure, superficial venous system
    • May also be due to incompetence of the venous valves in the higher pressure, deep venous system or, rarely, in both
  • It may also result from congenital absence of the valves
  • Risk factors include age, smoking, obesity and sedentary vocations
  • Subcutaneous dystrophic calcification is relatively common in chronic venous insufficiency that is severe or of long duration

Clinical Findings

  • Pruritus
  • Edema
  • Discoloration and thickening of the skin
  • Pain
  • Can lead to skin ulceration and infections

Imaging Findings

  • Duplex ultrasonography is the study of choice for the evaluation of venous insufficiency syndromes
  • Subcutaneous dystrophic calcification may be evident on conventional radiographs
  • Types of calcification
    • Punctate
    • Trabecular
    • Reticular types.
  • Patients with trabecular/reticular types tend to have the disease longer and more severely
  • May be associated with wavy, meta-diaphyseal periosteal reaction (stasis periostitis)

Differential Diagnosis

  • Calcinosis universalis in polymyositis/dermatomyositis
    • More sheet-like; more prevalent in proximal portions of extremities
  • Myositis ossificans/heterotopic ossification
    • Begin as cloud-like calcification that may proceed to sheet-like or rim-like calcifications

Treatment

  • Graduated compression
  • Surgical treatment usually reserved for those in whom medical management is not sufficient

Complications

  • Involvement of more veins as venous pressure increases (recruitment)
  • Deep  venous thrombosis
  • Pulmonary embolism
  • Venous ulceration
  • Lymphedema 

Chronic Venous Insufficiency

Chronic Venous Insufficiency. Frontal radiographs of both lower extremities show diffuse subcutaneous, reticular calcifications characteristic of chronic venous insufficiency.
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Latent dystrophic subcutaneous calcification in patients with chronic venous insufficiency. S Tokoro S, T Satoh, Y Okubo,  K Igawa K and H  Yokozeki. Acta Derm Venereol. 2009;89(5):505-8. doi: 10.2340/00015555-0680.