Patient Description of Venous Stasis
Older adults with a history of DVT and limited mobility typically describe venous stasis as leg pain, swelling, and skin changes that worsen throughout the day, particularly after prolonged standing or sitting. 1
Primary Symptom Presentation
The characteristic triad of symptoms patients report includes:
- Leg pain that is often described as aching, heaviness, or cramping in the affected lower extremity 1
- Progressive swelling (edema) that accumulates during the day and may improve with leg elevation 1
- Skin changes including discoloration, redness, and visible alterations in skin texture 1
Pathophysiologic Basis of Symptoms
The symptoms arise from venous hypertension caused by outflow obstruction and venous valve damage following DVT. 1 This sustained elevated venous pressure leads to:
- Chronic venous insufficiency that manifests as the post-thrombotic syndrome (PTS) 1
- Inflammatory cell accumulation and extravasation across vascular endothelium in the lower extremities 2
- Leukocyte trapping in the microcirculation and perivascular space, which contributes to the trophic skin changes patients observe 2
Specific Patient-Reported Features
Patients with limited mobility are particularly vulnerable because calf muscle pump failure exacerbates venous hypertension. 2 They commonly describe:
- Venous claudication - discomfort or cramping with walking that differs from arterial claudication 1
- End-of-day leg swelling that creates a sensation of tightness or fullness 1
- Visible dilated superficial collateral veins that patients notice as prominent, rope-like structures 1
Advanced Manifestations
In more severe cases, patients describe:
- Stasis dermatitis presenting as itching, scaling, and brownish discoloration (hemosiderin deposition) of the lower legs 1, 3
- Lipodermatosclerosis - indurated, hardened skin that patients describe as their leg feeling "woody" or "tight" 4
- Chronic debilitating pain that significantly impacts daily activities and quality of life 1
- Intractable edema that persists despite elevation and compression 1
Clinical Significance
Post-thrombotic syndrome develops in 22.8% of patients at 2 years, 28% at 5 years, and 29.1% at 8 years following DVT. 1, 5 After a first episode of proximal DVT:
- Mild-to-moderate PTS occurs in approximately 50% of patients 1, 5
- Severe PTS develops in 23% of patients 1, 5
- The syndrome is more likely after recurrent DVT episodes 1
Important Clinical Caveat
Patients may not spontaneously report these symptoms as related to their prior DVT, particularly if the acute event occurred months or years earlier. 1 Direct questioning about leg heaviness, end-of-day swelling, skin changes, and activity limitations is essential, as many older adults with limited mobility may attribute these symptoms to "normal aging" rather than recognizing them as manifestations of chronic venous insufficiency. 1