What is Chronic Venous Disease?

Numerous factors contribute to the development of chronic venous disease. Some of the primary causes and risk factors include:

• Genetics: A family history of venous disorders can increase an individual’s susceptibility to CVD.
• Age: The risk of CVD increases with age due to natural wear and tear on the venous system.
• Prolonged sitting or Standing: Occupations that involve extended periods of sitting or standing can impede venous blood flow, contributing to venous insufficiency.
• Obesity: Excessive body weight puts additional pressure on the veins and can impair venous return.
• Pregnancy: Hormonal changes during pregnancy and the pressure of the growing uterus on pelvic veins can lead to venous insufficiency.
• History of deep vein thrombosis (DVT): A past episode of DVT can damage valves and veins, increasing the risk of developing CVD.

The clinical presentation of chronic venous disease can vary widely, ranging from no symptoms to severe symptoms. Common signs and symptoms include:

• Varicose veins: Enlarged, twisted, and bulging veins that are often blue or purple, commonly seen in the legs.
• Leg heaviness and fatigue: Patients may experience a sensation of heaviness or tiredness in the legs, especially after prolonged standing or sitting.
• Edema: Swelling in the lower legs and ankles due to fluid accumulation caused by venous congestion.
• Skin changes: Chronic venous disease can lead to skin problems such as venous eczema or dermatitis (reddish skin discoloration, itching, and dryness).
• Hemosiderin staining: Brownish discoloration of the skin in the calf.
• Lipodermatosclerosis: A condition characterized by fibrosis and hardening of the skin and subcutaneous tissues.
• Venous ulcers: In advanced stages, open wounds may develop in the calf/ankle.
• Other complications (Chapter 7, see also Phlebitis and Bleeding on the website):
  • Bleeding: Veins very near the skin surface can tear and bleed after scratching or minor trauma.
  • Phlebitis: Inflammation of a superficial vein (varicose vein) with the formation of a blood clot.

The management of chronic venous disease aims to relieve symptoms, prevent complications, and improve patients’ quality of life. The treatment options include:

• Lifestyle modifications: Encouraging regular physical activity, weight management, and avoiding prolonged periods of sitting or standing.
• Compression therapy: Wearing compression stockings can improve venous blood flow, reduce edema, and alleviate symptoms.
• Sclerotherapy: Injection of a sclerosant solution into varicose veins to cause their closure and subsequent reabsorption.
• Phlebectomy: Removal of bulging varicose veins, which can be performed in the office.
• Surgical Interventions: For severe cases or complications, surgical procedures like vein ligation and stripping may be considered.
• Endovenous ablation: Minimally invasive procedures, such as laser or radiofrequency ablation, mechano-chemical ablation, and cyanoacrylate glue sealant, are used to treat underlying venous reflux.

Chronic venous disease is a prevalent condition with a wide range of clinical presentations and potential complications. Early recognition, appropriate diagnosis, and timely intervention are crucial in preventing disease progression and improving outcomes. By implementing a combination of lifestyle modifications, conservative measures, and medical interventions, your physician or non-physician provider can help you effectively manage CVD and enhance your quality of life.