Chronic venous insufficiency
Chronic venous insufficiency is impaired venous return from valvular incompetence or obstruction, causing ambulatory venous hypertension with leg heaviness, edema, skin changes, and venous ulcers. The cornerstone of treatment is compression therapy and leg elevation, with endovenous ablation for symptomatic superficial reflux.
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What this article covers
- Overview
Definition: chronic venous insufficiency (chronic venous disease) is impaired venous return in the lower limbs from valvular incompetence, obstruction, or calf pump failure, producing sustained ambulatory venous hypertension.
- Epidemiology
Very common, increasing with age and in women.
- Risk factors
Age, female sex, and family history. Prior deep vein thrombosis (post-thrombotic syndrome).
- Pathophysiology
Venous hypertension: valvular reflux or obstruction prevents effective venous emptying, so pressure remains high during ambulation.
- Clinical features
Leg heaviness, aching, and fatigue worse with standing, relieved by elevation.
- Differential diagnosis
Lymphedema: non-pitting edema involving the foot and toes, distinguished by a positive Stemmer sign and sparing of the typical venous skin changes (Lymphedema).
- Diagnosis
Establish clinically and grade with the CEAP classification, confirming reflux or obstruction on venous duplex: the diagnostic basis is the characteristic history and skin findings graded by the CEAP…
- Management
First-line, compression therapy and leg elevation: graduated compression stockings (and multilayer compression bandaging for active ulcers), leg elevation, exercise, and weight loss, after confirming adequate arterial supply.
- Complications
Chronic and recurrent venous ulcers. Stasis dermatitis and secondary infection: pruritic, often bilateral eczematous plaques with medial distal leg predominance; acute stasis dermatitis weeps with…
- Prognosis
Symptoms and ulcers improve substantially with compression.
- Prevention
Graduated compression stockings (20 to 30 mmHg) in at-risk patients and after deep vein thrombosis.
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Related articles
- Post-thrombotic syndrome
Post-thrombotic syndrome is chronic venous insufficiency developing after deep vein thrombosis, from valvular damage and residual obstruction. It causes chronic limb pain, swelling, skin changes, and sometimes ulcers, is graded by the Villalta score, and is managed with compression, exercise, and, for severe iliofemoral disease, venous stenting.
- Superficial venous thrombosis
Superficial venous thrombosis is thrombosis of a superficial vein, presenting as a tender, warm, palpable cord, often in a varicose vein. Once considered benign, extensive disease near the deep system carries a real risk of extension to deep vein thrombosis, so evaluation includes ultrasound and treatment may include prophylactic-dose anticoagulation.
- Lymphedema
Lymphedema is chronic tissue swelling from impaired lymphatic drainage, primary (developmental) or secondary (from surgery, radiation, infection, or malignancy). It causes progressive non-pitting edema that involves the toes, and management is decongestive therapy with compression, skin care, and cellulitis prevention, since there is no curative drug.
- Heart failure
Heart failure is a clinical syndrome of impaired cardiac filling or ejection causing congestion and reduced perfusion, classified by ejection fraction. Diagnosis integrates symptoms, signs, natriuretic peptides, and echocardiography, and treatment of reduced-ejection-fraction disease is quadruple guideline-directed therapy, with device therapy and cause-specific management.
- Peripheral artery disease (PAD)
Peripheral artery disease is atherosclerotic narrowing of the limb arteries, most often causing exertional claudication and, when advanced, chronic limb-threatening ischemia. It is a strong marker of systemic atherosclerosis, diagnosed by the ankle-brachial index, and managed with aggressive risk-factor control, antiplatelet therapy, exercise, and revascularization for severe disease.