Lower Extremity Chronic Venous Disease - Physicians
By Bryan Kramer, MD and Grace Boyle, OMS-II - December 30, 2019
Definition: spectrum of lower extremity vein abnormalities that may be morphologic and/or functional in nature that lead to venous dilation
Go Back - May or may not be symptomatic
- Inadequate muscle pumps
- Incompetent venous valves (reflux)
- Venous thrombosis (clotting)
- Non-thrombotic venous stenosis
- Advanced age
- Family history of venous disease
- Smoking
- Sedentary lifestyle
- Lower extremity trauma
- Prior venous thrombosis
- Pregnancy
- Symptoms: calf pain, leg heaviness and aching, swelling of the calves, muscle cramps, and skin irritation (tightness, dryness, itching)
- Clinical signs:
- Telangiectasias: dilated intradermal and subdermal veins (spider veins)
- Most prevalent clinical sign
- Varicose veins: dilated, elongated, tortuous, dilated subcutaneous veins
- >/= 3 mm in diameter
- Often concerning to patients for cosmetic reasons
- Telangiectasias: dilated intradermal and subdermal veins (spider veins)
- Signs of more advanced disease:
- Edema (swelling)
- Skin changes
- Hyperpigmentation (discoloration) and induration (hardening)
- Ulceration
- Other causes of edema, skin changes, and non-healing wounds:
- Heart failure, DVT, cellulitis, lymphedema, medication side effect, diabetes, infection, etc.
- Asymptomatic:
- Consult patients about cosmetic treatment for telangiectasias and varicose veins
- Symptomatic:
- Imaging: venous reflux duplex ultrasound
- Confirms the presence of reflux
- Treatment based on severity of reflux
- Confirms the presence of reflux
- Imaging: venous reflux duplex ultrasound
- Conservative treatment: exercise, leg elevation, compression, and skin care
- Varicose veins without axial venous reflux:
- Sclerotherapy
- Phlebectomy
- With superficial venous reflux:
- Superficial (great saphenous and small saphenous) venous ablation
- Ablation recommended prior to varicose vein excision
- Superficial (great saphenous and small saphenous) venous ablation
- With deep venous reflux:
- Venogram with angioplasty/stenting
- Valve repair