Surgical management of chronic venous insufficiency

Chronic venous insufficiency is a pathologic condition of the skin and subcutaneous tissues in the lower extremity caused by stasis of the blood flow. Incompetency or failure of the venous valves results in reflux and ambulatory venous hypertension, which is more severe with deep than with superficial venous incompetency. Superficial chronic venous insufficiency (varicose veins) is effectively managed with ligation and stripping of incompetent perforator and superficial veins to restore normal venous physiology. Deep chronic venous insufficiency (postphlebitic leg) presents a widespread pathologic disorder that is refractory to surgical correction. Adjunctive surgical measures such as removal of incompetent perforators or superficial veins to lessen local stasis or skin grafting of ulcers are often indicated in selected cases. The underlying chronic venous insufficiency requires management with elastic compression, elevation of the legs, and exercise for best results.