From the Guidelines
Venous hypertension can be categorized into different types, including ambulatory venous hypertension, which occurs due to outflow obstruction or valvular incompetence, and is a key factor in the development of postthrombotic syndrome (PTS) 1. The main types of venous hypertension include:
- Ambulatory venous hypertension, which occurs when there is outflow obstruction or valvular incompetence, leading to increased venous pressure during walking or standing
- Venous valvular reflux, which occurs when the valves in the veins become damaged, allowing blood to flow backwards and causing increased pressure
- Outflow obstruction, which occurs when there is a blockage in the veins, preventing blood from flowing back to the heart These types of venous hypertension can lead to various symptoms and complications, including leg pain and swelling, varicose veins, edema, skin changes, and ulceration 1. In the context of PTS, ambulatory venous hypertension can occur due to outflow obstruction or valvular incompetence, resulting in insufficient reduction in venous pressure with walking, leading to ambulatory hypertension 1. It is essential to understand the specific type of venous hypertension to provide appropriate treatment and prevent complications, as management depends on the underlying cause and may involve lifestyle modifications, compression therapy, medications, or other interventions 1.
From the Research
Types of Venous Hypertension
- Superficial venous hypertension: occurs due to insufficiency of the superficial venous valves, often caused by axial reflux via the sapheno-femoral and sapheno-popliteal anastomoses 2
- Deep venous hypertension: results from dysfunction of the musculovenous pump of the lower extremities, primary valvular insufficiency of the deep veins, and formation of hemodynamically significant refluxes in the deep, superficial, and perforating veins 2
- Venous hypertension secondary to superficial or deep venous valvular reflux: can lead to chronic venous insufficiency (CVI) and is often treated with compression therapy, pharmacologic agents, and endovascular or surgical techniques 3
- Venous hypertension caused by deep venous obstruction (DVO): can be treated with ablation of superficial venous reflux (SVR) and deep venous stenting, with some studies suggesting better outcomes when SVR ablation is combined with treatment of iliac vein obstruction 4
Characteristics of Venous Hypertension
- Superficial venous hypertension is more common, occurring in 85.3% of patients with varicosity, while deep venous hypertension occurs in 14.7% of patients 2
- Venous hypertension can cause stasis dermatitis, with evidence suggesting that venous hypertension alone can cause lower leg dermatitis 5
- Compression therapy can help reduce venous hypertension and alleviate symptoms of CVI, with different methods of compression therapy available, including static compression, specialized compression pumps, and manual lymphatic drainage 6