Venous Insufficiency

Excerpt

Venous insufficiency is a condition in which the flow of superficial or deep venous blood is impaired, causing venous hypertension. Chronic venous insufficiency (CVI) encompasses several pathological changes (eg, lower extremity edema, skin trophic changes, cramping, and wounds) that result secondary to venous hypertension. CVI is a prevalent disease process worldwide. Disability associated with CVI contributes to diminished quality of life and reduced work productivity. In most cases, the underlying cause of CVI is incompetent venous valves. Each year, approximately 150,000 new patients are diagnosed with CVI, and nearly $500 million is spent on the care of these patients. If left untreated, CVI is usually progressive and leads to postphlebitic syndrome and venous ulcers. Other common symptoms include pain, leg swelling, pruritus, skin discoloration, limb heaviness, and edema that improves with elevation.

The diagnosis of CVI is based on clinical features and confirmatory diagnostic studies. International consensus through the American Venous Forum developed the Clinical, Etiology, Anatomic, and Pathophysiology (CEAP) classification to improve consistency in reporting, diagnosis, and management of CVI. Venous duplex ultrasound is the primary modality to confirm a CVI diagnosis and is considered the gold standard. In addition to complementing the CEAP, the revised Venous Clinical Severity Score (VCSS) was developed to help assess CVI severity and determine the efficacy of CVD treatments. The approach to CVI management involves several different strategies, including conservative therapies (eg, compression, elevation, and exercise), pharmacologic treatments, and more invasive procedures (eg, sclerotherapy, endovenous laser, radiofrequency ablation, or surgical ligation). Delayed treatment can result in a more rapid disease progression, leading to complications including venous ulcers, infection, and deep vein thrombosis.