Superficial venous thrombosis, varicose veins, and chronic venous insufficiency: an update for clinical practice

Abstract

Venous disorders affect alarge proportion of the German population (varicose veins 13.3%, chronic venous insufficiency 40.8%). Based on current literature, apractically oriented update on superficial venous thrombosis, varicosis, and chronic venous insufficiency is provided. Superficial vein thrombosis of the legs requires comprehensive duplex ultrasonography of the superficial and deep leg veins. Only superficial vein thrombosis less than 5 cm in length and more than 3 cm from the saphenofemoral or saphenopopliteal junction can be treated conservatively with compression, cooling, and relative immobilization. Superficial vein thrombosis greater than 5 cm in length with more than 3 cm distance to the deep venous system is treated pharmacologically with fondaparinux for 45days (approved for 30-45days). If the surface thrombus reaches the saphenofemoral or saphenopopliteal junction at adistance of less than 3 cm, therapy analogous to deep vein thrombosis is required for 3months. The most effective therapy for varicose veins is invasive removal. In this regard, endovenous thermal ablation has become particularly important in recent years, given that its effectiveness is of asimilar order of magnitude to that of crossectomy and stripping surgery, but the complication rates are significantly lower. Invasive removal of varicose veins not only improves patients' quality of life, but also significantly reduces the risk of deep vein thrombosis. Recent epidemiological data demonstrate an increased risk of cardiovascular disease in patients with chronic venous insufficiency. There is preliminary evidence that this risk of cardiovascular disease in varicose vein patients can be lowered by varicose vein therapy.