Obesity

Some patients with a high body mass index have skin changes in the gaiter area which include eczema, lipodermatosclerosis and occasionally venous ulceration. Furthermore, weight loss often results in a reversal of these changes. Therefore, the assumption of an underlying venous insufficiency is valid. These include venous reflux, calf muscle pump impairment secondary to less mobility and perhaps the most important, an increased resistance to venous return secondary to higher intra-abdominal pressures. Measurement of these parameters and their relative importance in the development of chronic venous insufficiency, taking into account the sedentary lifestyle of these patients, is an under researched area. The lack of an accurate test in quantifying venous outflow resistance using physiological tests at different postures only adds to the difficulty.