Chronic venous disease

Last updated: March 24, 2022

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The most common chronic venous diseases are varicose veins (affecting approx. 23% of the US population) and chronic venous insufficiency (CVI), which affects 2–5% of the population. The condition is most often caused by increased venous pressure due to malfunctioning valves in the veins. Elevated venous pressure results in fluid accumulation in the lower extremities, leading to alterations in the skin and veins. Depending on the severity of hemodynamic changes, clinical manifestations may include superficial tortuous veins, edema, skin changes (e.g., stasis dermatitis), and ulcer formation. Diagnosis is established based on duplex ultrasonography. In complicated cases, magnetic resonance venography (MRV) may be performed as well. Treatment may be conservative (e.g., compression stockings) or involve ablation therapies (e.g., sclerotherapy, surgical excision).

Epidemiological data refers to the US, unless otherwise specified.

Risk factors for chronic venous disease include the following:

  • Increasing age; and female sex
  • Family history of venous disease
  • Ligamentous laxity
  • Sedentary lifestyle and prolonged standing
  • Obesity
  • Pregnancy
  • Smoking
  • Prior thrombosis (postthrombotic syndrome)
  • Prior extremity trauma
  • Congenital abnormalities

In healthy individuals, blood from the superficial leg veins passes through the perforating veins into the deep veins.

Varicose veins and chronic venous insufficiency are diagnosed based on history and clinical findings. Imaging is only used when a clinical diagnosis of CVI cannot be established and/or conservative management has failed.

General treatment principles

  • Elimination of the reflux pathways (via conservative, interventional, or surgical treatment options) → long-term normalization of hemodynamics prevention/slowing of CVI progression

Conservative measures [4]

Definite treatment [4]

Venous ulcers [5]

Differential diagnosis of foot ulcers

Differential diagnosis of lower leg ulcers
Venous ulcer Arterial ulcer Malum perforans
(neuropathic ulcer)
  • Gaiter region (above the ankle)
  • Diabetic microvasculopathy and neuropathy → impaired tissue sustenance
Wound features
  • Punched-out appearance
  • No exudation
  • Mild
  • Severe
  • Absent
Additional features

Further complications

We list the most important complications. The selection is not exhaustive.

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  2. Al Shammeri O, AlHamdan N, Al-Hothaly B, Midhet F, Hussain M, Al-Mohaimeed A. Chronic Venous Insufficiency: prevalence and effect of compression stockings.. Int J Health Sci. 2014; 8 (3): p.231-6. doi: 10.12816/0023975 . | Open in Read by QxMD
  3. Piazza G. Varicose Veins. Circulation. 2014; 130 (7): p.582-587. doi: 10.1161/circulationaha.113.008331 . | Open in Read by QxMD
  4. Alguire PC, Scovell S, Eidt JF, Mills JR, Collins KA. Overview and management of lower extremity chronic venous disease. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate.§ionRank=1&anchor=H26#H1.Last updated: July 27, 2016. Accessed: December 7, 2016.
  5. Leg ulcers (and disorders of venous insufficiency). Updated: October 17, 2016. Accessed: March 8, 2017.
  6. Practice guidelines - Superficial Venous Disease.
  7. Herold G. Internal Medicine. Herold G ; 2014
  8. Arterial Ulcers. Updated: March 8, 2017. Accessed: March 8, 2017.

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