Authored By: Dr. Bryan Kramer, MD and Grace Boyle, OMS-II
What is Lower Extremity Chronic Venous Disease?
Definition:
Spectrum of lower extremity vein abnormalities that may be morphologic and/or functional in nature that lead to venous dilation
- May or may not be symptomatic
Causes:
- Inadequate muscle pumps
- Incompetent venous valves (reflux)
- Venous thrombosis (clotting)
- Non-thrombotic venous stenosis
Risk Factors:
- Advanced age
- Family history of venous disease
- Smoking
- Sedentary lifestyle
- Lower extremity trauma
- Prior venous thrombosis
- Pregnancy
Symptoms and Clinical Signs:
- 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
Differential:
Other causes of edema, skin changes, and non-healing wounds:
- Heart failure, DVT, cellulitis, lymphedema, medication side effect, diabetes, infection, etc.
Management:
- 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
Treatment:
- 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
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