Chronic venous insufficiency

Chronic venous disease is a common problem that has a significant impact on afflicted individuals and the healthcare system. Normal venous function requires the axial veins with a series of venous valves, perforating veins to allow communication of the superficial to the deep venous system, and the venous muscle pumps. Dysfunction of any of the normal structures may lead to venous hypertension and the development of CVI. There is a spectrum of manifestations of CVI with an emphasis on more serious consequences such as venous ulceration. There are a number of noninvasive and invasive techniques that assist in diagnosis and treatment. The most commonly used technique is the use of venous duplex reflux evaluation to confirm the diagnosis and provide anatomic detail. The use of air plethysmography often is used to assist in assessing the severity of disease. The treatment of CVI is based on the severity of disease and guided by anatomic and pathophysiological considerations. Compressive garments have been a mainstay in treatment and should be included in the treatment of CVI. Traditional surgical techniques and newer interventional methods often are reserved for unsatisfactory response to conservative measures, although the earlier use of techniques such as venous ablation is considered. © 2005 American Heart Association, Inc.