Diagnostic evaluation of chronic venous insufficiency
- 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
More severe clinical manifestations of chronic venous disease including edema (which may be unilateral), skin changes, and venous ulceration are often sufficient to establish a diagnosis of chronic venous insufficiency. However, objective testing may be needed to confirm the diagnosis, determine the etiology (reflux, obstruction, or reflux and obstruction), localize the anatomic site and severity of disease , or identify concurrent peripheral artery disease.
Diagnostic testing identifies patients with venous pathology who may benefit from vein ablation treatments, which are effective in controlling vein-related symptoms and decreasing the incidence of recurrent ulceration in those with superficial venous reflux.
The diagnostic tests available to evaluate the patient with suspected chronic venous insufficiency are reviewed. The pathophysiology, clinical manifestations, and treatment of this disorder are discussed separately. (See "Clinical manifestations of lower extremity chronic venous disease" and "Pathophysiology of chronic venous disease" and "Radiofrequency ablation for the treatment of lower extremity chronic venous disease" and "Endovenous laser ablation for the treatment of lower extremity chronic venous disease".)
APPROACH TO THE PATIENT
Localized lower extremity edema and pigmentation strongly support the diagnosis of venous hypertension (picture 1). The history and physical examination are sufficient in many cases for eliminating systemic causes of venous hypertension (eg, hypervolemia, heart failure). (See "Clinical manifestations of lower extremity chronic venous disease" and "Clinical manifestations and diagnosis of edema in adults", section on 'Venous insufficiency or thrombosis' and "Clinical assessment of wounds", section on 'Differentiation of chronic ulcers'.)
A duplex ultrasound examination can confirm the presence of venous obstruction or valvular incompetence as the cause of venous hypertension, and is used for planning venous ablation procedures [1,2], but is not necessary in all cases of suspected venous insufficiency where intervention is not being considered. (See 'Duplex ultrasonography' below.)
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