Sensory impairment: A feature of chronic venous insufficiency

Objective: Clinical and microscopic evidence suggests the existence of sensory neuropathy in patients with severe chronic venous insufficiency (CVI). A clinical evaluation was conducted to determine whether a sensory neuropathy was present and, if so, to determine its extent and distribution. Method...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of vascular surgery Vol. 30; no. 5; pp. 836 - 843
Main Authors:	Padberg, Frank T., Maniker, Allen H., Carmel, Gwendolyn, Pappas, Peter J., Silva, Micheal B., Hobson, Robert W.
Format:	Journal Article
Language:	English
Published:	United States Mosby, Inc 01-11-1999
Subjects:	Arm - innervation Humans Leg - innervation Male Neurologic Examination Peripheral Nervous System Diseases - diagnosis Peripheral Nervous System Diseases - etiology Plethysmography Sensory Thresholds Skin - innervation Ultrasonography, Doppler, Duplex Venous Insufficiency - complications Venous Insufficiency - diagnostic imaging Venous Insufficiency - physiopathology
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objective: Clinical and microscopic evidence suggests the existence of sensory neuropathy in patients with severe chronic venous insufficiency (CVI). A clinical evaluation was conducted to determine whether a sensory neuropathy was present and, if so, to determine its extent and distribution. Methods: The study was performed in a university-affiliated Veterans Affairs Medical Center. Twenty-three limbs were studied in 14 male veterans with mild or moderate CVI. The exclusions included diabetes, previous ipsilateral extremity surgery, or other diseases associated with neuropathy. Sensory thresholds in the limbs with CEAP class 2 disease (n = 11) were compared with the thresholds in the limbs with CEAP class 5 disease (n = 12) at nine different sites on the foot, ankle, calf, thigh, and palm. Thenar and hypothenar thresholds were measured as internal controls. Thresholds were determined by a pressure aesthesiometer consisting of 20 graduated filaments that ranged from 1.65 to 6.65 (log 10mg)(10) of pressure. A complete, sensory motor assessment of the limb was performed by an experienced neurosurgeon who specialized in peripheral nerve evaluation. The clinical variables assessed were deep tendon reflexes, vibration, proprioception, and light touch. Venous reflux was determined with duplex ultrasound scanning and air plethysmography. Results: Sensory thresholds at the most common site of venous ulceration—just proximal to the medial malleolus—were significantly ( P < .05) different between mild (class 2) and severe (class 5) CVI. Sensory abnormalities coincided with the extent of trophic changes and did not reflect specific dermatomal or cutaneous nerve distributions. In addition to light touch or pinprick, vibration sense and deep tendon reflexes were also significantly worse in those with severe CVI. Conclusion: Sensory neuropathy is a feature of severe CVI, and its distribution is coincident with trophic changes. Because this is often unappreciated by the patient, it probably contributes to the propensity for deterioration from minor trauma. (J Vasc Surg 1999;30:836-43.)
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0741-5214 1097-6809
DOI:	10.1016/S0741-5214(99)70008-X