1. Chapter Eleven Venous Disease Coalition Chronic Venous Insufficiency VTE Toolkit

2. Post-Thrombotic Venous Reflux Disease VTE Toolkit Seen in 20-50% of patients after DVT 1 1.Deep vein valves become damaged by DVT resulting in venous valve failure 2.Reflux or backward flow in the deep veins occurs 3.Pooling of blood causes increased pressure in leg veins, edema, hyperpigmentation Dilated Vein Heart Foot Valve Open Valve Closed Leaky Valve Normal Vein Reproduced with permission of VNUS Medical Technologies, CA 1. Antithrombotic and Thrombolytic Therapy 8 th edition, ACCP Guidelines

3. Chronic Venous Disease VTE Toolkit

4. Telangiectases C 1 Varicose veins C 2 Pigmentation C 4 Active Ulceration C 6 Bergan – NEJM 2006;355:488

5. Post-Thrombotic Syndrome VTE Toolkit Prospective study of 355 patients with DVT All patients advised to wear 40 mmHg stockings  PTS - recurrent, ipsilateral DVT NOT - extent of DVT Prandoni - Ann Intern Med (1996) Years since Cumulative DVT Incidence of PTS 1 17 % 2 23 % 5 28 % 8 29 %

6. Prevention and Management of Post-Thrombotic Syndrome VTE Toolkit Prevent recurrent DVT with anticoagulation Encourage the obsessive use of good quality compression stockings = ESSENTIAL Encourage regular exercise Encourage normal body weight Avoid local trauma to the legs Aggressive management of stasis dermatitis Urgent expert treatment of early ulcers

7. Venous Disease Coalition www.vasculardisease.org/venousdiseasecoalition/ VTE Toolkit