This chapter addresses venous insufficiency in otherwise healthy persons who may require exceptional considerations to control their symptoms.
Venous insufficiency is very unusual in young people. When present, there is almost always a history of trauma, often dating back a few years. One cause may be intravenous catheterizations performed years before during a critical illness. Congenital absence of the valves does occur but rarely; swelling or discomfort of the legs that result do not usually become apparent until the teen years. Injury of a leg is notoriously common in contact sports. Also leading to thrombophlebitis and subsequent venous valvular dysfunction in teenagers and young adults are injections of street drugs.
Lymphedema from a congenital abnormality of the lymph drainage system usually has its onset in young people; its appearance at first is very much like that of venous insufficiency. Custom-fitted stockings have been made to control lymphedema for patients as young as 2 years.
In addition, one must consider the possibilities of a vascular malformation. Sometimes a tumor or a large lymph node in the groin or pelvis will press against the iliac or femoral vein, causing leg swelling.
Leg edema that is bilateral and symmetrical can be the earliest symptoms of an abnormality of the heart or pericardium, the liver, or the kidneys. Discomfort in a leg on prolonged standing or associated with athletics (excluding trauma) is commonly associated with a shortened leg or other structural, weight-bearing problem. These possibilities can usually be excluded by fairly simple diagnostic examinations. It should be evident that the diagnosis of venous insufficiency in the youthful patient must be made with particular care.
Treatment of documented venous insufficiency in young people is not different from that for adults, although compliance in this style-conscious age group is often challenging. In particularly, adolescents loathe having to follow a regimen of extended leg elevation and to wearing compression hose. Nevertheless, there is much at stake in preventing progressive enlargement and discomfort of the legs over the many decades of expected life ahead.
Ordinarily, pregnancy causes only a slight degree of ankle swelling, most notable during the last few months. This “physiological” edema occurs in both legs. Its causes are complex, but compression of the veins leading into the pelvis in late pregnancy is likely the leading factor. In addition, expectant mothers may be less active while experiencing drastic hormonal changes that tend to retain body fluid and soften the supporting tissues.
An unusual degree of edema occurring before the third trimester, warrants evaluation for thrombosis or reflux in the deep veins. This consideration is even more compelling if the amount of leg swelling is greater on one leg than the other or if a leg becomes painful, tender, or discolored.