Which symptom is least likely to improve with leg elevation in patients with chronic venous insufficiency?

In patients with chronic venous insufficiency, leg elevation is typically beneficial for alleviating symptoms related to venous congestion. Symptoms such as pain, swelling, and heaviness generally improve with elevation because this position helps reduce venous pressure and promotes venous return to the heart.

Swelling, in particular, is often significantly responsive to elevation as it reduces the hydrostatic pressure in the veins, facilitating fluid reabsorption from the interstitial spaces back into the vascular system. Pain and the sensation of heaviness also tend to diminish as the reduced pressure lessens the strain on the venous walls.

In contrast, skin changes resulting from chronic venous insufficiency, such as dermatitis, hyperpigmentation, or venous ulcers, relate more to chronic structural changes in the skin and underlying tissues than to immediate venous pressure issues. These skin alterations often result from long-term venous stasis and may not show significant improvement solely from leg elevation. Thus, while elevation can provide symptomatic relief for acute manifestations of chronic venous insufficiency, it is the skin changes that are least likely to improve and may require more comprehensive treatment strategies.