Skip to main content

Presentation of Chronic Venous Disease

  • Chapter
  • First Online:
Phlebology, Vein Surgery and Ultrasonography

Abstract

An estimated 20–25 million people in the USA have varicose veins, while up to 20 % of people worldwide have CVI. Diagnosis, treatment, and surveillance may be routine and singularly focused or may be staged and multifactorial. An area that has proven to benefit from the use of protocols and standardized surveys is surveillance. Follow-up care of patients with varying disease severity over time has been successfully performed using the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification and the Venous Clinical Severity Score (VCSS), evaluation scales that provide reproducible results. This chapter examines assessment, epidemiology, and symptoms and physical findings in patients with CVD and CVI.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vascular Disease Foundation. Learn about vascular disease. http://www.vdf.org/. Accessed 27 Oct 2011.

  2. Venous Disease Coalition. Learn about venous disease. http://www.venousdiseasecoalition.org/. Accessed 27 Oct 2011.

  3. Gloviczki P, Comerota AJ, Dalsing MC, Eklöf BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53:2S–48.

    Article  PubMed  Google Scholar 

  4. Vasquez MA, Wang J, Mahathanaruk M, Buczkowski G, Sprehe E, Dosluoglu HH. The utility of the Venous Clinical Severity Score in 682 limbs treated by radiofrequency saphenous vein ablation. J Vasc Surg. 2007;45:1008–15.

    Article  PubMed  Google Scholar 

  5. Meissner MH, Natiello C, Nicholls SC. Performance characteristics of the Venous Clinical Severity Score. J Vasc Surg. 2002;36:889–95.

    Article  PubMed  Google Scholar 

  6. Vasquez MA, Munschauer CE. Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology. 2008;23:259–75.

    Article  PubMed  CAS  Google Scholar 

  7. Dayal R, Kent KC. Standardized reporting practices. In: Rutherford RB, editor. Vascular surgery. 6th ed. Philadelphia: WB Saunders; 2005. p. 41–52.

    Google Scholar 

  8. Kundu S, Lurie F, Millward SF, Padberg F, Vedantham S, Elias S, Khilnani NM, Marston W, Cardella JF, Meissner MH, Dalsing MC, Clark TWI, Min RJ. Recommended reporting standards for endovenous ablation for the treatment of venous insufficiency: joint statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Surg. 2007;46:582–9.

    Article  PubMed  Google Scholar 

  9. Gloviczki P. Presidential address: venous surgery: from stepchild to equal partner. J Vasc Surg. 2003;38:871–8.

    Article  PubMed  Google Scholar 

  10. Min RJ, Khilnani NM, Golia P. Duplex ultrasound evaluation of lower extremity venous insufficiency. J Vasc Interv Radiol. 2003;14:1233–41.

    Article  PubMed  Google Scholar 

  11. Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, Meissner MH, Moneta GL, Myers K, Padberg FT, Perrin M, Ruckley CV, Smith PC, Wakefield TW, American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40:1248–52.

    Article  PubMed  Google Scholar 

  12. Meissner MH, Gloviczki P, Bergan J, Kistner RL, Morrison N, Pannier F, Pappas PJ, Rabe E, Raju S, Villavicencio JL. Primary chronic venous disorders. J Vasc Surg. 2007;46:54S–67.

    Article  PubMed  Google Scholar 

  13. Meissner MH, Moneta G, Burnand K, Gloviczki P, Lohr JM, Lurie F, Mattos MA, McLafferty RB, Mozes G, Rutherford RB, Padberg F, Summer DS. The hemodynamics and diagnosis of venous disease. J Vasc Surg. 2007;46:4S–24.

    Article  PubMed  Google Scholar 

  14. Chiesa R, Marone EM, Limoni C, Volonte M, Petrini O. Chronic venous disorders: correlation between visible signs, symptoms and presence of functional disease. J Vasc Surg. 2007;46:322–30.

    Article  PubMed  Google Scholar 

  15. Kistner RL, Eklöf B. Classification and etiology of chronic venous disease. In: Gloviczki P, editor. Handbook of venous disorders. 3rd ed. London: Hodder Arnold; 2009. p. 37–46.

    Google Scholar 

  16. Kakkos SK, Rivera MA, Matsagas MI, Lazarides MK, Robless P, Belcaro G, Geroulakos G. Validation of the new venous severity scoring system in varicose vein surgery. J Vasc Surg. 2003;38:224–8.

    Article  PubMed  Google Scholar 

  17. Ricci MA, Emmerich J, Callas PW, Rosendaal FR, Stanley AC, Naud S, Vossen C. Evaluating chronic venous disease with a new venous severity scoring system. J Vasc Surg. 2003;38:909–15.

    Article  PubMed  Google Scholar 

  18. Rutherford RB, Padberg FT, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: an adjunct to venous outcome assessment. J Vasc Surg. 2000;31:1307–12.

    Article  PubMed  CAS  Google Scholar 

  19. Gillett JL, Perrin MR, Allaert FA. Clinical presentation and venous severity scoring of patients with extended deep axial vein reflux. J Vasc Surg. 2006;44:588–94.

    Article  Google Scholar 

  20. Vasquez MA, Rabe E, McLafferty RB, Shortell CK, Marston WA, Gillespie D, Meissner MH, Rutherford RB. Revision of the Venous Clinical Severity Score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010;52:1387–96.

    Article  PubMed  Google Scholar 

  21. Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P, American Venous Forum; European Venous Forum; International Union of Phlebology; American College of Phlebology; International Union of Angiology. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49:498–501.

    Article  PubMed  Google Scholar 

  22. Perrin MR, Labropoulos N, Leon Jr LR. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006;43:327–34.

    Article  PubMed  Google Scholar 

  23. Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklöf B. Chronic venous disease. N Engl J Med. 2006;355:488–98.

    Article  PubMed  CAS  Google Scholar 

  24. Thorisson HM, Pollack JS, Scoutt L. The role of ultrasound in the diagnosis and treatment of chronic venous insufficiency. Ultrasound Q. 2007;23(2):137–50.

    Article  PubMed  Google Scholar 

  25. Rutherford RB. Presidential address: vascular surgery: comparing outcomes. J Vasc Surg. 1996;23:5–17.

    Article  PubMed  CAS  Google Scholar 

  26. Meissner MH. “I enjoyed your talk, but…”: evidence-based medicine and the scientific foundation of the American Venous Forum. J Vasc Surg. 2009;49(1):244–8.

    Article  PubMed  Google Scholar 

  27. Rabe E, Pannier F. Epidemiology of chronic venous disorders. In: Gloviczki P, editor. Handbook of venous disorders. 3rd ed. London: Hodder Arnold; 2009. p. 105–10.

    Google Scholar 

  28. Rabe E, Pannier F. What have we learned from the Bonn Vein study? Phlebolymphology. 2006;13:188–94.

    Google Scholar 

  29. Criqui MH, Denenberg JO, Langer RD, Kaplan RM, Fronek A. Epidemiology of chronic peripheral venous disease. In: Bergan JJ, editor. The vein book. Burlington: Elsevier Academic Press; 2007. p. 27–37.

    Chapter  Google Scholar 

  30. O’Donnell TF. Lessons from the past guide the future: is history truly circular? J Vasc Surg. 1999;30(5):775–86.

    Article  PubMed  Google Scholar 

  31. Merchant RF, Pichot O. Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency. J Vasc Surg. 2005;42:502–9.

    Article  PubMed  Google Scholar 

  32. Vasquez MA, Munschauer CE. Clinical and surrogate outcomes from the new radiofrequency catheter: an experience of 700 limbs. In: Greenhalgh R, editor. Vascular and endovascular challenges update. Bodmin: MPG Books Ltd; 2010. p. 425–33.

    Google Scholar 

  33. Mayo Clinic. Varicose veins. 2011. http://www.mayoclinic.com/health/varicose-veins/DS00256. Accessed 28 Oct 2011.

  34. Mayo Clinic. Peripheral artery disease (PAD). 2010. http://www.mayoclinic.com/health/peripheral-arterial-disease/DS00537. Accessed 28 Oct 2011. Mayo Foundation for Medical Education and Research.

  35. Carr SC. Current management of varicose veins. Clin Obstet Gynecol. 2006;49(2):414–26.

    Article  PubMed  Google Scholar 

  36. Neglén P, Thrasher TL, Raju S. Venous outflow obstruction: an underestimated contributor to chronic venous disease. J Vasc Surg. 2003;38:879–85.

    Article  PubMed  Google Scholar 

  37. Meissner MH, Eklöf B, Smith PC, Dalsing MC, DePalma RG, Gloviczki P, Moneta G, Neglén P, O’Donnell T, Partsch H, Raju S. Secondary chronic venous disorders. J Vasc Surg. 2007;46(suppl S):68S–83.

    Article  PubMed  Google Scholar 

  38. Raju S, Neglén P. High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: a permissive role in pathogenicity. J Vasc Surg. 2006;44:136–44.

    Article  PubMed  Google Scholar 

  39. Porter JM, Rutherford RB, Clagett GP, Cranley JJ, O’Donnell TF, Raju S, Zierler RE, Browse N, Nicolaides A. Reporting standards in venous disease. J Vasc Surg. 1988;8:172–81.

    Google Scholar 

  40. Paraskevas P. Femoral vein duplication: incidence and potential significance. Phlebology. 2011;26:52–5.

    Article  PubMed  CAS  Google Scholar 

  41. Neglén P, Hollis KC, Raju S. Combined saphenous ablation and iliac stent placement for complex severe chronic venous disease. J Vasc Surg. 2006;44:828–33.

    Article  PubMed  Google Scholar 

  42. Neglén P, Hollis KC, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg. 2007;46:979–90.

    Article  PubMed  Google Scholar 

  43. Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002;35:694–700.

    Article  PubMed  Google Scholar 

  44. Lurie F, Creton D, Eklöf B, Kabnick LS, Kistner RL, Pichot O, Schuller-Petrovic S, Sessa C. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg. 2003;38(2):207–14.

    Article  PubMed  CAS  Google Scholar 

  45. Caradice D, Mekako AI, Hatfield J, Chetter IC. Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Br J Surg. 2009;96:369–75.

    Article  Google Scholar 

  46. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol. 2003;14(8):991–6.

    Article  PubMed  Google Scholar 

  47. Monahan DL. Can phlebectomy be deferred in the treatment of varicose veins? J Vasc Surg. 2005;42:1145–9.

    Article  PubMed  Google Scholar 

  48. Theivacumar NS, Dellagrammaticas D, Mavor AI, Gough MJ. Endovenous laser ablation: does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg. 2008;48:173–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael A. Vasquez MD, FACS, RVT .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Vasquez, M.A., Munschauer, C. (2014). Presentation of Chronic Venous Disease. In: Mowatt-Larssen, E., Desai, S., Dua, A., Shortell, C. (eds) Phlebology, Vein Surgery and Ultrasonography. Springer, Cham. https://doi.org/10.1007/978-3-319-01812-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-01812-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-01811-9

  • Online ISBN: 978-3-319-01812-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics