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Chronic venous insufficiency

Última revisão: 13 Sep 2025
Última atualização: 23 Jul 2025

Resumo

Definition

History and exam

Key diagnostic factors

  • corona phlebectatica (malleolar flare or ankle flare)
  • ankle swelling
  • hyperpigmentation (brawny edema)
  • lipodermatosclerosis
  • atrophie blanche
  • leg ulcers
Full details

Other diagnostic factors

  • leg fatigue, aching, and/or discomfort
  • heavy legs
  • leg cramps
  • telangiectasias
  • reticular veins
  • dilated tortuous veins
  • dry and scaly skin
  • skin burning and itching
  • unilateral leg swelling
Full details

Risk factors

  • increasing age
  • family history
  • smoking
  • deep vein thrombosis
  • orthostatic occupation
  • female sex
  • obesity (waist circumference)
  • ligamentous laxity
Full details

Diagnostic tests

1st tests to order

  • duplex ultrasound
Full details

Tests to consider

  • ascending phlebography
  • CT venography
  • magnetic resonance venography
  • CT abdomen and pelvis
  • abdomen and pelvis ultrasound
  • intravascular ultrasound
  • air plethysmography
Full details

Treatment algorithm

ONGOING

all symptomatic patients

Contributors

Authors

Joseph L. Mills Sr, MD

Professor and Chief

Division of Vascular Surgery and Endovascular Therapy

Michael E. DeBakey Department of Surgery

Baylor College of Medicine

Houston

TX

Disclosures

JLM declares that he has no competing interests.

David G. Armstrong, DPM, MD, PhD

Professor of Surgery

Director of Southwestern Academic Limb Salvage Alliance (SALSA)

Keck School of Medicine of University of Southern California (USC)

Los Angeles

CA

Declarações

DGA declares that his work is partially supported by grants from the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases.

Revisores

Anahita Dua, MD, MS, MBA, FACS

Assistant Professor of Surgery

Massachusetts General Hospital/Harvard Medical School

Boston

MA

Declarações

AD declares that she has no competing interests.

Paul Tisi, MBBS, MS, FRCSEd

Medical Director/Consultant Vascular Surgeon

Bedford Hospital

Bedford

UK

Declarações

PT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020 May;8(3):342-52. Resumo

De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022 Feb;63(2):184-267.Texto completo  Resumo

Bergan JJ, Schmid-Schönbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. 2006 Aug 3;355(5):488-98. Resumo

American Vein and Lymphatic Society (American College of Phlebology). Treatment of superficial venous disease of the lower leg. Feb 2016 [internet publication].Texto completo

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