Chronic Venous Insufficiency

Chronic venous insufficiency of the lower extremities is a complicated disorder that affects the productivity and well-being of millions of people worldwide. Management requires careful differential diagnosis and a systematic long-term multidisciplinary care effort directed toward realistic goals within the context of the patient's lifestyle. Optimal therapy requires control of abnormal venous physiology combined with adjunctive treatments to correct secondary skin ulceration, infection, and lymphedema. Fundamental management tools are limb elevation, simple dressings, antibiotics, and elastic compression garments. Patients with large leg ulcers may benefit from split-thickness skin grafting. Other selected patients may benefit from ligation and stripping of superficial veins or subfascial interruption of perforating veins. New endoscopic methods have dramatically reduced morbidity from subfascial perforator surgery. Surgery directed at correcting valvular reflux and venous occlusion is possible in highly selected patients.