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Venostasis: Causes, Symptoms, Complications & Treatment

Definition

Venostasis (venous stasis) is impaired venous return leading to blood pooling in the dependent veins, most commonly the lower extremities.

Pathophysiology

Normal venous return relies on the calf muscle pump, competent venous valves, and intact vascular tone. Failure of any component causes venous hypertension, capillary leakage, and tissue changes.

Risk Factors

  • Venous valve incompetence (primary varicose veins, post-thrombotic syndrome).
  • Deep vein thrombosis (DVT) – acute or chronic obstruction.
  • Obesity, pregnancy, prolonged standing/sitting.
  • Heart failure, cirrhosis (increased hydrostatic pressure).
  • Age-related loss of venous tone.

Clinical Manifestations

  • Edema (ankles, calves), worsening with dependency.
  • Aching, heaviness, cramping.
  • Varicose veins, telangiectasias.
  • Skin changes: hyperpigmentation (hemosiderin), lipodermatosclerosis, atrophie blanche.
  • Venous ulcers (gaiter area, medial malleolus).

Complications

  • Superficial thrombophlebitis.
  • Recurrent DVT / pulmonary embolism.
  • Cellulitis, contact dermatitis.
  • Chronic venous insufficiency (CVI) disability.

Management

  • Conservative: Leg elevation, compression stockings (20–30 or 30–40 mmHg), exercise, weight loss, skin care.
  • Pharmacologic: Venotonics (diosmin/hesperidin), topical steroids for stasis dermatitis, pentoxifylline for ulcers.
  • Interventional: Endovenous ablation (radiofrequency, laser), sclerotherapy, venous stenting for iliac obstruction.
  • Surgical: Vein stripping, perforator ligation, ulcer debridement/grafting.

Prevention

Early treatment of DVT, compression during prolonged immobilization, weight control, regular calf-muscle exercise.

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