Chronic venous disorders(CVI) encompass a spectrum of venous disease includes varicose veins, edema, and skin changes and ulcers affecting the lower limb.
CVI includes manifestations such as skin pigmentation, venous eczema, lipodermatosclerosis, atrophie blanche, and healed or active ulcers.
CVD, including varicose veins and CVI, is an extremely common medical condition that has a significant impact on an individual’s health. The most common estimates of the prevalence of varicose veins have been between 5% and 30% in the adult population, but reports have ranged from less than 1% to greater than 70%.
The most serious consequences of CVI, namely, venous ulcers, either active or healed, are seen in approximately 1% of the adult population.
Risk factors associated with the first time development of a venous ulcer include maternal family history, physical activity, and history of deep venous thrombosis. The overall prognosis of venous ulcers is poor, with delayed healing and recurrent ulceration being very common. A majority of venous ulcers will require prolonged therapy, often lasting longer than a year.
An even greater socioeconomic impact is seen with more advanced venous disease. Venous ulceration has dramatic consequences that impair an individual’s ability to engage in social and occupational activities, reduces QoL(Quality of life), and imposes financial constraints.
Venous pathology develops when venous pressure is increased and return of blood is impaired through several mechanisms including valvular incompetence of the axial deep or superficial veins, perforator valve incompetence or venous obstruction and Muscle pump dysfunction.
Dysfunction of the valves of the deep system is most often due to previous Deep vein thrombosis.
The initial management of CVD involves measures such as leg elevation to minimize edema and structured weight loss programs , Use of compressive stockings, Wound and Skin Care, Pharmacologic Therapy and Exercise.
If medical measures fail then Interventional Management such as Sclerotherapy may be used as primary treatment or in conjunction with Endovenous Ablation for obliterating telangiectases, reticular veins, varicose veins, and saphenous segments with reflux.
Endovenous deep system therapy in the management of CVD with Iliac vein Stenting in approximately 10% to 30% of patients with severe CVI have been found to have a significant abnormality in venous outflow involving iliac vein segments resulted in complete ulcer healing in 50% of patients.