Chronic venous insufficiency
Chronic venous disease (CVD) is extremely common, affecting 60 per cent of the western population. By Patrick Tosenovsky, Vascular Surgeon.
19 Dec 2017
19 December 2017
CVD is defined as any venous disease affecting legs with signs/symptoms requiring investigation. It includes spider veins on the least morbid side of the spectrum but also leg ulcers as the most severe presentation of CVD. For any advanced manifestation of CVD the term ‘Chronic Venous Insufficiency’ (CVI) is often used.
Examples of CVI are legs with skin discolouration, healed or active leg ulcers, or any symptoms including venous claudication or chronic swelling caused by venous congestion.
The major pathology causing venous congestion is obstruction and/or reflux both causing increased venous pressure in the leg – venous hypertension.
Recently published guidelines and recommendations suggest thorough investigation for patients with CVI (particularly for severely symptomatic patients) include:
- CT Venography (CTV)
- MR Venography
- Formal Venography or
- IntraVascular Ultra Sound (IVUS) in order to identify obstruction.
Obstruction is often present in the area not assessed by formal leg ultrasound examination and therefore is often missed.
Iliac vein pathology is repairable with very good results if performed by specialised interventionist. Significant improvement of a patient’s quality of life, improved venous symptoms including the ulcer-healing rate have been published after percutaneous venoplasty and stenting.
Summary
A specialist with experience in deep venous reconstructions should assess any CVI patient. Post-thrombotic syndrome can be treated more efficiently than with elastic compression hosiery alone and a better quality of life can be achieved with appropriate intervention.
Recommended resources:
- NICE Guidelines on VTE 2012: https://www.nice.org.uk/guidance/cg144
- The care of patients with chronic venous disease: Clinical Practice Guidelines of the Society for Vascular Surgery and The American Venous Forum: http://www.jvascsurg.org/article/S0741-5214(11)00327-2/abstract
- CVD European Guidelines 2015: http://www.ejves.com/article/S1078-5884(17)30454-9/fulltext
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