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Chronic Venous Disease of the Lower Extremities: A State-of-the Art Review
Robert R Attaran1, Jeffrey G Carr2
1Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.
Insights
Chronic venous disease, common and age-related, causes leg ulcers and impacts quality of life. Treatment includes compression therapy and advanced catheter techniques for venous obstruction and reflux.
Area of Science:
- Vascular Medicine
- Cardiology
Background:
- Chronic venous disease (CVD) is prevalent, increasing with age, and significantly impacts quality of life.
- Risk factors for CVD include genetics, female sex, obesity, pregnancy, and deep vein thrombosis history.
- CVD leads to ambulatory venous hypertension due to venous obstruction, reflux, or both, causing leg ulcers and healthcare costs.
Purpose of the Study:
- To review the pathophysiology, risk factors, and current treatment modalities for chronic venous disease.
- To highlight the efficacy of compression therapy, catheter-based interventions, and recanalization techniques.
- To emphasize the need for improved training and guidelines for managing CVD.
Main Methods:
- Review of existing literature on chronic venous disease.
- Analysis of treatment outcomes for compression therapy, thermal and nonthermal catheter techniques, and venous recanalization.
- Discussion of risk factors and diagnostic considerations.
Main Results:
- Superficial saphenous vein reflux and deep vein obstruction are key contributors to symptomatic CVD.
- Catheter techniques (thermal and nonthermal) show efficacy and safety for venous closure and symptom improvement.
- Recanalization with balloons and stents is increasingly utilized for deep vein obstruction.
Conclusions:
- Compression therapy is foundational for advanced CVD.
- Minimally invasive catheter techniques offer effective treatment options for superficial and deep venous issues.
- Enhanced training and evidence-based guidelines are crucial for optimal cardiologist management of CVD.
Abstract:
Chronic venous disease is a common disease, the prevalence of which increases with age, and can cause debilitating symptoms that adversely affect the quality of life. The risk factors include family history, female sex, obesity, pregnancy, parity, and history of deep vein thrombosis. Moreover, it is associated with venous obstruction, reflux, or both, which, in turn, leads to ambulatory venous hypertension. Chronic venous disease is the leading cause of leg ulcers, which place a significant cost burden on the health care system. Compression therapy remains the cornerstone of treatment, particularly for more advanced disease. Superficial saphenous vein reflux can be associated with significant symptoms. Catheter techniques, both thermal and nonthermal, have demonstrated efficacy and safety in successful closure and symptom improvement. Deep vein obstruction can be broadly divided into thrombotic and nonthrombotic and can lead to symptomatic chronic venous disease. Recanalization using balloons and stents has been increasingly used and studied in such patients. It is critical to develop training opportunities and guidelines to improve evidence-based and appropriate care for cardiologists treating chronic venous disease.
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