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Chronic venous disease

Last updated: February 23, 2021

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The most common chronic venous diseases are varicose veins (affecting approx. 23% of the US population) and chronic venous insufficiency (CVI), which affects 2–5% of the population. The condition is most often caused by increased venous pressure due to malfunctioning valves in the veins. Elevated venous pressure results in fluid accumulation in the lower extremities, leading to alterations in the skin and veins. Depending on the severity of hemodynamic changes, clinical manifestations may include superficial tortuous veins, edema, skin changes (e.g., stasis dermatitis), and ulcer formation. Diagnosis is established based on duplex ultrasonography. In complicated cases, magnetic resonance venography (MRV) may be performed as well. Treatment may be conservative (e.g., compression stockings) or involve ablation therapies (e.g., sclerotherapy, surgical excision).

  • Varicose veins: cylindrical extension and dilation of superficial veins (diameter > 3 mm) with development of knots and tortuous veins
  • Chronic venous insufficiency: increased venous pressure resulting in alterations of the skin and veins



Epidemiological data refers to the US, unless otherwise specified.

Risk factors for chronic venous disease

  • Increasing age and female sex (see “Epidemiology” above)
  • Family history of venous disease
  • Ligamentous laxity
  • Sedentary lifestyle and prolonged standing
  • Obesity
  • Pregnancy
  • Smoking
  • Prior thrombosis; (postthrombotic syndrome)
  • Prior extremity trauma
  • Congenital abnormalities

In healthy individuals, blood from the superficial leg veins passes through the perforating veins into the deep veins.

Varicose veins

Chronic venous insufficiency

  • Chief complaints: generalized or localized pain, lower extremity discomfort/cramping, and limb swelling
    • Worsened by heat
    • Worse while standing, relieved by walking and raising of legs
    • Occurs in ∼ 50% of affected individuals
  • Pruritus, tingling, and numbness
  • Skin findings


The diagnosis of varicose veins is based on history and clinical findings; . Imaging is only used in the diagnosis of CVI.


General treatment principles

  • Elimination of the reflux pathways (via conservative, interventional, or surgical treatment options) → long-term normalization of hemodynamics → prevention/slowing of CVI progression

Conservative measures

Definite treatment

  • Indications:
    • Symptomatic venous disease with correctable cause of reflux
    • In case of complications such as bleeding, ulcers, or recurrent superficial thrombophlebitis (also see “Complications” below)
  • Technique: vein ablation therapies
    • Interventional:
    • Open surgery with partial or complete removal of a vein: only for veins that are not accessible by interventional techniques


Venous ulcers

Further complications


We list the most important complications. The selection is not exhaustive.

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