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Overview and management of lower extremity chronic venous disease

Patrick C Alguire, MD, FACP
Sherry Scovell, MD, FACS
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Chronic venous disease refers to a wide spectrum of morphologic (ie, venous dilation) and/or functional abnormalities (eg, venous reflux) of long duration [1-3]. Vein-related problems may or may not be symptomatic and include a wide range of clinical signs that vary from minimal superficial venous dilation to chronic skin changes with ulceration.


Inadequate muscle pump function, incompetent venous valves (reflux), and venous thrombosis or obstruction are causes of elevated venous pressure (venous hypertension), which initiates a sequence of anatomic, physiologic, and histologic changes leading to vein dilation, skin changes, or skin ulceration. The factors that determine whether a given patient will progress from mild to more severe disease are largely unknown. The pathophysiology of chronic venous disease is discussed in detail elsewhere. (See "Pathophysiology of chronic venous disease" and "Post-thrombotic (postphlebitic) syndrome", section on 'Pathophysiology'.)


Chronic vein abnormalities are present in up to 50 percent of individuals [4-7]. However, estimates of prevalence rates of chronic venous disease vary depending upon the population studied [8].

Epidemiologic studies typically focus on defined subsets based upon the visible manifestations of venous disease. Study populations are generally limited to either those with mild abnormalities (telangiectasias, reticular veins), or uncomplicated varicose veins with or without venous reflux, or longstanding venous insufficiency (ie, skin changes, venous ulceration). (See 'Clinical features' below.)

While it is convenient to stratify the study of venous abnormalities in this manner, it is important to remember that these subsets represent varying levels of disease severity in a spectrum of a single pathology; risk factors for development are the same. (See 'Risk factors' below.)


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Literature review current through: Sep 2016. | This topic last updated: Jul 27, 2016.
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