Has anyone been diagnosed with CVI prior to developing EM or even after? Does anyone know if there is a causative relationship here? Now I am finding that there is just so much pressure in my feet when I am standing or sitting. Feels like all the blood is pooling there, so I can't stand or sit comfortably anymore. Now I'm only "comfortable" when my feet are elevated. Is this normal with EM even without CVI? I had some vein work done on my legs several years ago to treat varicose veins in my right leg, so I'm pretty sure I had or perhaps still have CVI. Also, I noticed that in the weeks and months before I developed my EM symptoms I had swelling in my feet and ankles. When I would take off my socks, the socks would leave an imprint all over my feet and ankles. Then the EM came on.
Related question - has anyone gotten relief from EM symptoms by wearing compression stockings? I pulled my old ones out that I had from my time during vein treatments and have put them on. I hate putting anything over even the lower half of my feet, but at least the toes are open.
CVI is considered a differential diagnosis from EM. Kalgaard, 2012 describes CVI in this context as:
Chronic venous insuffiency. In this condition classified according to the CEAP clinical classification of lower extremity venous disease, stage C4a with pigmentation and eczema (Porter and Moneta, 1995) erythema and increased skin temperature with painful discomfort may be present, but the patients do not generally experience relief from cooling.
If concurrent in the same patient, symptoms of CVI and EM would be difficult to attribute individually.
That's a helpful description of CVI. I had CVI in my right leg before having a major vein zapped by EVLT. My symptoms on the affected leg at the time were similar to what is described above, but in reality felt and looked very different from what I now experience with EM. I think it would be hard to confuse the two in clinical presentation. I don't recall increased skin temperature, but rather a dull painful ache and redness. I know that I've read in some sources on line that EM can be secondary to CVI. This kind of makes sense to me intuitively - if you have venous disease present in your extremities then you could be pre-disposed to developing EM.
Excellent analysis, snowshoe03! Kalgaard, 2012 also described the pathogenesis of EM:
In most textbooks EM is considered to be a separate disease entity. Our group has argued that EM represents a symptom complex, a condition rather than a well defined disease (Kvernebo, 2003).
Hypothesis: Microvascular shunting as the final common pathway of pathogenesis.
The hypothesis that symptoms are caused by skin microvascular arteriovenous (AV) shunting with corresponding tissue hypoxia and hyperaemia independent of the aetiology, has been proposed by our group (Kvernebo, 1998). This is analogous to the view that inflammation is not one single disease, but a physiologic response to stimuli such as infection, trauma, or tumour. Further we believe that the microvascular AV shunting may be induced by a number of mechanisms and diseases (Kvernebo, 1998; Mørk, 2004b).