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Clinical Features of Venous Insufficiency - Vein Expert at Buffalo Niagara
Tuesday, August 13, 2013



There are several key clinical features of venous insufficiency that are notable. There may be lower extremity swelling or edema and evidence of skin changes.  One of the early signs of skin changes in mild eczema of the skin, also known as gravitational eczema or venous stasis eczema.  The CEAP classification for venous stasis dermatitis is CEAP C4a.


Another early sign of injury to the skin in patients with venous insufficiency is hyperpigmentation or brown pigmentation of the skin due to the deposition of hemosiderin in the skin.  This occurs due to combination of reasons but mainly due to high venous pressures or venous hypertension which results directly from damage from the muscle pumping function in these patients.  This causes red blood cells to leak out of the capillaries and get deposited in the skin.  Breakdown of the red blood cells and hemoglobin forms hemosiderin deposition.  The clinical classification of hyperpigmentation resulting from chronic venous disease is CEAP C4.


Another serious manifestation of longstanding venous insufficiency is lipodermatosclerosis where there is induration or hardening of the skin as well as a leathery texture of the skin and subcutaneous tissue.  This affects the gaiter areas of the leg - the areas just above the ankle bone or malleolus.  Lipodermatosclerosis may be the precursor to more advanced venous stasis disease such as venous stasis ulceration.  In lipodermatosclerosis, there is contraction of the dermis and subcutaneous tissues and the area above the ankle is circumferentially narrower compared to the normal leg.  This pushes the calf muscle upward resulting in a ‘upside down champaigne bottle” appearance of the leg. The CEAP classification for lipodermatosclerosis in patients with advanced venous diseases is CEAP C4b.


Atrophe blance may also develop and in this condition the superficial blood vessels are obliterated or disappear from the skin and white patches of skin develop.  This indicates that the skin has been severely damaged by chronic venous valvular insufficiency.  These patients are at risk of developing venous stasis ulcers. 


The CEAP classification for venous stasis ulceration is CEAP C6.  A healed venous stasis ulcera is classified as CEAP C5.


For more information about lipodermatosclerosis and advanced clinical features of venous insufficiency contact Hratch Karamanoukian, MD FACS at the Vein Treatment Center with offices in Williamsville, New York and Clarence, New York or contact him directly through or  You can also schedule a consultation by calling 716-839-3638. and are partners with



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