Snapshot A 45-year-old man presents to the primary care physician with pain in his left calf. Physical exam reveals swelling of the right ankle, reddish-brown discoloration of the skin around the ankle and bilateral calves, and a small area of ulceration over the medial malleolus. Nontender superficial varicosities are also noted. The femoral, popliteal, and dordalis pulses are strong. Introduction Venous insufficiency (valvular insufficiency) as a diagnostic term generally refers to the lower extremities Patients may have a known history of DVT Presentation Symptoms swelling and pain, fatigability, and heaviness of the lower limbs all of which are usually relieved by leg elevation patients might also complain of varicose veins Physical exam stasis dermatitis rusty discoloration of the skin, with or without ulceration often located around the ankles caused by hemosiderin deposited in the skin following venous rupture superficial varicosities, or varicose veins occur secondary to depp venous insufficiency visible on the surface of the limb often not aesthetically pleasing skin breakdown ulceration Evaluation Diagnosis made by physical exam Doppler Ultrasound used primarily to identify venous thrombus or other signs of blockage Differential Superficial thrombophlebitis, diabetic vasculitis, Buerger's vasculitis, deep venous thrombus, pressure ulcers Treatment Nonoperative conservative treatment elastic compression stockings leg elevation minimal standing treatment of ulcers with wet-to-dry dressings antibiotics only with evidence of cellulitis Operative limited in cases of venous insufficiency occasionally necessary for more severe and extensive ulcer debridement Prognosis, Prevention, and Comlications Prognosis highly dependent on severity of disease outcomes depend heavily on controlling coexisting conditions and active management via conservative treatment measures requires strict adherence by patient Prevention maintain healthy, active lifestyle including diet, exercise, and smoking cessation/abstention progression can be slowed with adherence to conservative treatment protocols Complications may be associated with DVT formation, and thus increased risk of PE