Clinical manifestations of lower extremity chronic venous disease
- Patrick C Alguire, MD, FACP
Patrick C Alguire, MD, FACP
- Senior Vice President for Medical Education
- American College of Physicians
- Barbara M Mathes, MD, FACP, FAAD
Barbara M Mathes, MD, FACP, FAAD
- Clinical Associate, Dermatology
- University of Pennsylvania
- Secretary Treasurer
- American Academy of Dermatology
- Section Editors
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery
- University of South Carolina School of Medicine Greenville
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
Chronic lower extremity venous disease is the most common vascular disorder . Chronic venous disease refers to the presence of morphological (ie, venous dilation) or functional (eg, venous reflux) abnormalities of long duration and manifested by symptoms and/or signs indicating the need for further investigation or treatment .
Chronic venous disease encompasses the full spectrum of signs and symptoms associated with classes CØ to C6 of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification (table 1), whereas the term "chronic venous insufficiency" is generally restricted to disease of greater severity (ie, classes C4 to C6) . Thus, varicose veins in the absence of skin changes are not indicative of chronic venous insufficiency.
Initial clinical presentation is highly variable with the most common symptoms consisting of lower extremity pain or discomfort. Physical findings include abnormal venous dilation (ie, telangiectasias, reticular veins, varicose veins), edema, inflammation, dermatitis, or ulceration. Chronic venous insufficiency is associated with chronic disability, diminished quality of life, and high health care costs [4-8].
The clinical evaluation of chronic venous disease is reviewed here. The classification, diagnostic evaluation and management of chronic venous disease are discussed elsewhere. (See "Classification of lower extremity chronic venous disorders" and "Overview and management of lower extremity chronic venous disease".)
APPROACH TO THE PATIENT
The diagnosis of chronic lower extremity venous disease is predominantly clinical. Initial evaluation consists of a thorough history and physical examination, with clinical classification of disease severity according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) criteria (table 1) . The CEAP classification is helpful in documenting venous disease severity both at initial presentation as well as in documenting changes over time. The CEAP clinical classification is discussed in detail elsewhere. (See "Classification of lower extremity chronic venous disorders" and 'Clinical signs by CEAP category' below.)
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- APPROACH TO THE PATIENT
- Risk factors for venous disease
- Medical history
- Quality of life
- PHYSICAL ASSESSMENT
- CLINICAL SIGNS BY CEAP CATEGORY
- No clinical signs
- Telangiectasia/reticular veins
- Varicose veins
- Skin pigmentation changes/dermatitis
- Venous ulceration
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS