Just as arterial disorders of the extremities can be acute or chronic, so can venous disorders. Therapeutic exercise is one aspect of management of patients with an acute disease, such as thrombophlebitis, or a chronic disorder, such as varicose veins or chronic venous insufficiency.

Types of Venous Disorders

Thrombophlebitis and Deep Vein Thrombosis

Thrombophlebitis is a disorder typically affecting the lower extremities and caused by thrombosis (the development/formation of a blood clot¾i.e., a thrombus). It is characterized by acute inflammation with partial or complete occlusion of a superficial or deep vein.

Lower extremity venous thrombosis can occur in the superficial vein system (greater or small saphenous veins) or the deep vein system (popliteal, femoral, or iliac veins). A thrombus in one of the superficial veins in the calf usually is small and resolves without serious consequences. In contrast, thrombus formation in a deep vein in the calf or more proximally in the thigh or pelvic region, known as a deep vein thrombosis (DVT), tends to be larger and can cause serious complications. When a clot breaks away from the wall of a vein and travels proximally, it is called an embolus. When an embolus affects pulmonary circulation, it is called a pulmonary embolism, which is a potentially life-threatening disorder.

A lower extremity DVT is a common complication after musculoskeletal injury or surgery, prolonged immobilization, or bed rest and is attributed to venous stasis, injury to and inflammation of the walls of a vein, or a hypercoagulable state of the blood.

Chronic Venous Insufficiency

Chronic venous insufficiency is defined as inadequate venous return over a prolonged period of time. It may begin after a severe episode of DVT, may be associated with varicose veins, or may be the result of trauma to the lower extremities or blockage of the venous system by a neoplasm. In all of these disorders damaged or incompetent valves in the veins prevent or compromise venous return, leading to venous hypertension and venous stasis in the lower extremities. Chronic pooling of blood in the veins causes inadequate oxygenation of cells and removal of waste products. This, in turn, leads to necrosis of tissues and the development of venous stasis ulcers.

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