Cardiovascular Disease: Chronic Venous Insufficiency and Varicose Veins

Chronic venous insufficiency (CVI) results from long-term venous hypertension in the legs caused by venous obstruction, venous valve incompetency, muscle pump dysfunction, or a combination of these. CVI occurs in 9.4% of men and 6.6% of women. It takes any of several forms, including leg pain and heaviness, leg edema that is worsened by prolonged standing and relieved by elevation, stasis dermatitis, skin fibrosis, skin ulcers, and varicose veins. If the patient history and/or physical examination results are suggestive of CVI, the diagnosis can be confirmed with duplex ultrasonography. The primary conservative treatment is use of compression stockings. Physical therapy and exercise programs often are recommended but little evidence supports their use. If a skin ulcer is present, appropriate wound care is indicated. Flavonoid drugs have been shown to improve venous function but none are approved for use in the United States. Diosmiplex, a flavonoid medical food product derived from oranges, is approved by the Food and Drug Administration for management of CVI and has shown some benefits. Patients with more severe manifestations of CVI should be referred to a vascular subspecialist for consideration of interventional therapies.