Clinical presentation includes increasing leg pain, fatigue, and heaviness with prolonged standing, associated with dilated tortuous veins.
More severe cases exhibit progressive skin changes, venous stasis dermatitis, lipodermatosclerosis, and frank ulceration.
Underlying venous insufficiency is most efficiently documented, localised, and graded by duplex ultrasound.
Conservative treatment requires graded compression.
Open surgical or endovenous treatment options may be used in highly selected cases.
Venous ulceration and bleeding are recognised complications.
Chronic venous insufficiency (CVI) refers to functional changes that may occur in the lower extremity due to persistent elevation of venous pressures. This most commonly results from venous reflux due to faulty valve function developing as a long-term sequela of deep vein thrombosis (DVT) and recanalisation and may also develop due to primary valvular incompetence without previous episode(s) of DVT. The term 'CVI' is usually reserved for more advanced disease involving oedema, skin changes, or frank ulcers.
History and exam
Key diagnostic factors
- presence of risk factors
- corona phlebectatica (malleolar flare or ankle flare)
- ankle swelling
- hyperpigmentation (brawny oedema)
- atrophie blanche
- leg ulcers
Other diagnostic factors
- leg fatigue, aching, and/or discomfort
- heavy legs
- leg cramps
- reticular veins
- dilated tortuous veins
- dry and scaly skin
- skin burning and itching
- unilateral leg swelling
- increasing age
- family history
- deep vein thrombosis
- orthostatic occupation
- female sex
- obesity (waist circumference)
- ligamentous laxity
1st investigations to order
- duplex ultrasound
Investigations to consider
- ascending phlebography
- CT venography
- magnetic resonance venography
- CT abdomen and pelvis
- intravascular ultrasound
- air plethysmography
all symptomatic patients
- Diabetic foot ulcer
- Arterial ulcer
- Squamous cell carcinoma (Marjolin)
- Endovenous mechanochemical ablation for varicose veins
- Practice guidelines for superficial venous disease (treatment of superficial venous disease of the lower leg)
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