References

Jameson L, Fauci A, Kasper D Harrison's principles of internal medicine, 20th ed. : McGraw-Hill Medical Publ. Division; 2018

Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014; 130:(4)333-346 https://doi.org/10.1161/CIRCULATIONAHA.113.006898

Santler B, Goerge T. Chronic venous insufficiency - a review of pathophysiology, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017; 15:(5)538-556 https://doi.org/10.1111/ddg.13242

Nicolaides AN, Labropoulos N. Burden and suffering in chronic venous disease. Adv Ther. 2019; 36:1-4 https://doi.org/10.1007/s12325-019-0882-6

Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005; 15:(3)175-184 https://doi.org/10.1016/j.annepidem.2004.05.015

Criqui MH, Denenberg JO, Bergan J Risk factors for chronic venous disease: The San Diego Population Study. J Vasc Surg. 2007; 46:(2)331-337 https://doi.org/10.1016/j.jvs.2007.03.052

Matic M, Matic A, Djuran V Frequency of peripheral arterial disease in patients with chronic venous insufficiency. Iran Red Crescent Med J. 2016; 18:(1) https://doi.org/10.5812/ircmj.20781

Baliyan V, Tajmir S, Hedgire SS Lower extremity venous reflux. Cardiovasc Diagn Ther. 2016; 6:(6)533-543 https://doi.org/10.21037/cdt.2016.11.14

Lee DK, Ahn KS, Kang CH, Cho SB. Ultrasonography of the lower extremity veins: anatomy and basic approach. Ultrasonography. 2017; 36:(2)120-130 https://doi.org/10.14366/usg.17001

Avogaro A, Albiero M, Menegazzo L Endothelial dysfunction in diabetes: the role of reparatory mechanisms. Diabetes Care. 2011; 34:S285-S290 https://doi.org/10.2337/dc11-s239

Raju S, Neglén P. Clinical practice. Chronic venous insufficiency and varicose veins. N Engl J Med. 2009; 360:(22)2319-2327 https://doi.org/10.1056/NEJMcp0802444

Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019; 34:(2)269-283 https://doi.org/10.3904/kjim.2018.230

Dini V, Janowska A, Oranges T Surrounding skin management in venous leg ulcers: a systematic review. J Tissue Viability. 2020; 29:(3)169-175 https://doi.org/10.1016/j.jtv.2020.02.004

Porter M. A case study of venous leg ulceration. Br J Community Nurs. 2018; 23:S30-S36 https://doi.org/10.12968/bjcn.2018.23.sup9.s30

Vivas A, Lev-Tov H, Kirsner RS. Venous leg ulcers. Ann Intern Med. 2016; 165:(3)ITC17-ITC32 https://doi.org/10.7326/AITC201608020

Vasudevan B. Venous leg ulcers: pathophysiology and classification. Indian Dermatol Online J. 2014; 5:(3)366-370 https://doi.org/10.4103/2229-5178.137819

García Botero A, Cantini Ardila JE, Devoz Borja LD, Gómez-Ortega V. A systematic literature review of the management of chronic venous ulcers with autologous fibrin matrix with or without growth factors. Plastic and Aesthetic Research. 2018; 5:(4) https://doi.org/10.20517/2347-9264.2018.09

Sen CK, Gordillo GM, Roy S Human skin wounds: A major and snowballing threat to public health and the economy. Wound Repair Regen. 2009; 17:(6)763-771 https://doi.org/10.1111/j.1524-475X.2009.00543.x

Rice JB, Desai U, Cummings AK Burden of venous leg ulcers in the United States. J Med Econ. 2014; 17:(5)347-356 https://doi.org/10.3111/13696998.2014.903258

Tiwary SK, Kumar PKG, Dhameeja N Assessment and grading of pigmentation in chronic venous insufficiency. Phleobology. 2020; 35:(6)394-401 https://doi.org/10.1177/0268355519885471

Centers for Medicare and Medicaid Services. Calendar year (CY) 2022 Medicare physician fee schedule final rule. 2021. https://tinyurl.com/3ss6bdwp (accessed 26 May 2022)

Masuda E, Ozsvath K, Vossler J The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 2020; 8:(4)505-525.e4 https://doi.org/10.1016/j.jvsv.2020.02.001

Vasquez MA, Rabe E, McLafferty RB Revision of the venous clinical severity score: Venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010; 52:(5)1387-1396 https://doi.org/10.1016/j.jvs.2010.06.161

O'Donnell TF, Passman MA, Marston WA Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014; 60:(2)3S-59S https://doi.org/10.1016/j.jvs.2014.04.049

Vasquez MA, Munschauer CE. Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology: The Journal of Venous Disease. 2008; 23:(6)259-275 https://doi.org/10.1258/phleb.2008.008018

Cires-Drouet RS, Fangyang L, Rosenberger S High prevalence of chronic venous disease among health care workers in the United States. J Vasc Surg Venous Lymphat Disord. 2020; 8:(2)224-230 https://doi.org/10.1016/j.jvsv.2019.10.017

Gloviczki P, Comerota AJ, Dalsing MC The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011; 53:2S-48S https://doi.org/10.1016/j.jvs.2011.01.079

Partsch H, Mortimer P. Compression for leg wounds. Br J Dermatol. 2015; 173:(2)359-369 https://doi.org/10.1111/bjd.13851

Lurie F, De Maeseneer MG. The 2020 Update of the CEAP Classification: what is New?. Eur J Vasc Endovasc Surg. 2020; 59:(6)859-860 https://doi.org/10.1016/j.ejvs.2020.04.020

Lurie F, Schwartz M. Patient-centered outcomes of a dual action pneumatic compression device in comparison to compression stockings for patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2017; 5:(5)699-706.e1 https://doi.org/10.1016/j.jvsv.2017.06.003

Berliner E, Ozbilgin B, Zarin DA. A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers. J Vasc Surg. 2003; 37:(3)539-544 https://doi.org/10.1067/mva.2003.103

Shingler S, Robertson L, Boghossian S, Stewart M. Compression stockings for the initial treatment of varicose veins in patients without venous ulceration. Cochrane Database Syst Rev. 2013; (12) https://doi.org/10.1002/14651858.CD008819.pub3

Raetz J, Wilson M, Collins K. Varicose veins: diagnosis and treatment. Am Fam Physician. 2019; 99:(11)682-688

American College of Phlebology. Treatment of superficial venous disease of the lower leg: practice guidelines: superficial venous disease rev020316. https://tinyurl.com/3m35dkaa (accessed 27 April 2022)

O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012; 11

Raju S, Hollis K, Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy. Ann Vasc Surg. 2007; 21:(6)790-795 https://doi.org/10.1016/j.avsg.2007.07.014

Kankam HK, Lim CS, Fiorentino F A summation analysis of compliance and complications of compression hosiery for patients with chronic venous disease or post-thrombotic syndrome. Eur J Vasc Endovasc Surg. 2018; 55:(3)406-416 https://doi.org/10.1016/j.ejvs.2017.11.025

Bush R, Comerota A, Meissner M Recommendations for the medical management of chronic venous disease: the role of micronized purified flavanoid fraction (MPFF). Phlebology. 2017; 32:3-19 https://doi.org/10.1177/0268355517692221

Scallon C, Bell-Syer SE, Aziz Z. Flavonoids for treating venous leg ulcers. Cochrane Database Syst Rev. 2013; (5)

Berti F, Omini C, Longiave D. The mode of action of Aescin and the release of prostaglandins. Prostaglandins. 1977; 14:(2)241-249 https://doi.org/10.1016/0090-6980(77)90169-1

Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2012; 11 https://doi.org/10.1002/14651858.CD003230.pub4

Ottillinger B, Greeske K. Rational therapy of chronic venous insufficiency – chances and limits of the therapeutic use of horse-chestnut seeds extract. BMC Cardiovasc Disord. 2001; 1:(1) https://doi.org/10.1186/1471-2261-1-5

Tisi PV, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev. 2006; (4)

de-Abreu GC, Camargo Júnior O, de-Abreu MF, de-Aquino JL. Ultrasound-guided foam sclerotherapy for severe chronic venous insufficiency. Rev Col Bras Cir. 2017; 44:(5)511-520 https://doi.org/10.1590/0100-69912017005014

Bootun R, Lane TR, Davies AH. A comparison of thermal and non-thermal ablation. Reviews in Vascular Medicine. 2016; 4-5:1-8 https://doi.org/10.1016/j.rvm.2016.02.001

Paravastu SC, Horne M, Dodd PD. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016; 2016:(11) https://doi.org/10.1002/14651858.CD010878.pub2

Kabnick LS, Sadek M. Fiber type as compared to wavelength may contribute more to improving postoperative recovery following endovenous laser ablation. J Vasc Surg Venous Lymphat Disord. 2016; 4:(3)286-292 https://doi.org/10.1016/j.jvsv.2015.12.004

Menyhei G, Gyevnár Z, Arató E Conventional stripping versus cryostripping: a prospective randomised trial to compare improvement in quality of life and complications. Eur J Vasc Endovasc Surg. 2008; 35:(2)218-223 https://doi.org/10.1016/j.ejvs.2007.08.017

Disselhoff BC, der Kinderen DJ, Kelder JC, Moll FL. Five-year results of a randomized clinical trial comparing endovenous laser ablation with cryostripping for great saphenous varicose veins. Br J Surg. 2011; 98:(8)1107-1111 https://doi.org/10.1002/bjs.7542

Venous Insufficiency. 2022. https://tinyurl.com/bdcp29a4 (accessed 27 April 2022)

Cho S, Joh JH. Cyanoacrylate closure of small saphenous vein insufficiency. Dermatol Surg. 2021; 47:(3)381-384 https://doi.org/10.1097/DSS.0000000000002748

Bissacco D, Stegher S, Calliari FM, Viani MP. Saphenous vein ablation with a new cyanoacrylate glue device: a systematic review on 1000 cases. Minim Invasive Ther Allied Technol. 2019; 28:(1)6-14 https://doi.org/10.1080/13645706.2018.1464029

Park I, Jeong MH, Park CJ Clinical features and management of ‘phlebitis-like abnormal reaction’ after cyanoacrylate closure for the treatment of incompetent saphenous veins. Ann Vasc Surg. 2019; 55:239-245 https://doi.org/10.1016/j.avsg.2018.07.040

Carter MJ, Fife CE. Clinic visit frequency in wound care matters: data from the US wound registry. J Wound Care. 2017; 26:S4-S10 https://doi.org/10.12968/jowc.2017.26.sup1.s4

Rogers LC, Lavery LA, Joseph WS, Armstrong DG. All feet on deck—the role of podiatry during the covid-19 pandemic: preventing hospitalizations in an overburdened healthcare system, reducing amputation and death in people with diabetes. J Am Podiatr Med Assoc. 2020; https://doi.org/10.7547/20-051

Prachand VN, Milner R, Angelos P Medically necessary, time-sensitive procedures: scoring system to ethically and efficiently manage resource scarcity and provider risk during the covid-19 pandemic. J Am Coll Surg. 2020; 231:(2)281-288 https://doi.org/10.1016/j.jamcollsurg.2020.04.011

Skeik N, Manunga J, Mirza A. Caring for patients with venous insufficiency during the COVID-19 pandemic at a tertiary care center. J Vasc Surg Venous Lymphat Disord. 2020; 8:(4) https://doi.org/10.1016/j.jvsv.2020.04.023

Buset CS, Fleischer J, Kluge R Compression stocking with 100% donning and doffing success: an open label randomised controlled trial. Eur J Vasc Endovasc Surg. 2021; 61:(1)137-144 https://doi.org/10.1016/j.ejvs.2020.09.027

Probst S, Saini C, Buehrer Skinner M. Development and feasibility of a multidisciplinary education program on adherence to treatment in persons with venous leg ulcers in the clinical setting: a pilot study. J Adv Nurs. 2020; 76:(10)2733-2736 https://doi.org/10.1111/jan.14502

Leg ulcers

Chronic venous insufficiency: a comprehensive review of management

02 July 2022
Practice
02 July 2022
Volume 6 · Issue 2

Abstract

Chronic venous insufficiency is an extensive progressive disease in need of public health attention. This insidious disease is a growing burden on patient quality of life and the health economy. Chronic venous insufficiency has become more pronounced in global populations, especially in regions exhibiting a higher rate of risk factors. It is critical for healthcare providers to recognise and intervene early to prevent ongoing and debilitating complications. This article provides a comprehensive review of chronic venous insufficiency outlining the anatomy, pathophysiology, clinical presentation, assessment and management options.

Chronic venous disease is a commonly underdiagnosed disease that progressively reduces a patient's quality of life (QoL) as well as placing an increasing burden on healthcare resources. Chronic venous disease involves telangiectasias, reticular veins, varicose veins, chronic venous insufficiency (CVI) and chronic venous hypertension. Symptoms of CVI include pain, skin discolouration, oedema and ulceration.1,2,3 More specifically, CVI is a condition affecting the lower extremity venous system and involves complex venous pathology.2,3 Prevalence of chronic venous disease should raise concern, especially as trends in longevity and obesity continue to rise.4 This article provides an overview of the anatomy, pathophysiology, clinical presentation and diagnosis of CVI, with a focus on management options to help improve early recognition and intervention.

The global prevalence of CVI varies widely, from <1–17% in men and <1–40% in women. These ranges are likely attributed to variations in the application of diagnostic criteria, the availability of medical resources to diagnose and treat, as well as the dispersion of risk factors unique to global populations.5 Common risk factors for CVI include: increasing age; family history of venous disease; smoking; obesity; prolonged standing or sitting; history of venous thrombosis; pregnancy; history of lower extremity trauma; or surgery.6 Women also show a higher incidence and prevalence of CVI than men at any age.1

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month

Register
Or continue by

Signing in with your registered email address

ablation
chronic venous disease
chronic venous insufficiency
CVI
management
varicose veins
veins
venous anatomy
venous ulcers
wound
wound care
wound healing