Chronic Venous Insufficiency

Abstract

Venous disease is widely prevalent. Patients seek treatment for a variety of problems ranging from unsightly veins, swelling, and aching to dermatitis and skin ulcerations. Quality of life is affected in those patients with chronic venous insufficiency (CVI). Venous valves are designed to keep blood flowing cephalad. Valvular incompetence can be caused by thrombosis, genetic factors, and other risk factors such as ambulatory jobs, obesity, and history of pregnancy. Blood pools in the affected limb, leading to venous hypertension in the surrounding tissue. The treatment of CVI is designed to diminish the effects of venous hypertension. Compression management has remained the most important treatment modality in both the short- and the long-term managements of venous disease. Surgical procedures were developed to reduce venous hypertension in the superficial venous system. These procedures have been essentially replaced by modern, less invasive treatment options. Venous ablation (radio frequency and laser) is designed to injure the venous endothelium and induce thrombosis in both perforator and axial veins. Ambulatory phlebectomy allows the practitioner to remove varicosities in the office setting. Sclerosant injection has been used for treating smaller veins, perforators, and spider veins. New techniques and new technology will continue to improve upon presently available treatment modalities.