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Chronic Venous Insufficiency, Varicose Vein and Management Options

Chronic Venous Insufficiency, Varicose Vein and Management Options | SingHealth

Chronic Venous Insufficiency, Varicose Vein and Management Options - What is it for

Lower limb venous physiology and function

  • The lower limb venous system overcomes gravity to return blood to the heart.
  • Calf muscle pump and the vein-valve system accomplish this efficiently.
  • Superficial veins function as principal collection system, dilating to accommodate large volumes of blood from tissue and skin before draining to the deep system for return to the heart.

The 2 major veins of the superficial system namely the Great Saphenous and Short Saphenous (GSV and SSV).

  • GSV originates medially from the dorsal vein of the foot and continues proximally along the medial aspect of the calf and thigh before joining the deep vein at the sapheno-femoral junction.
  • An anterior accessory is common in up to 14%
  • SSV originates inferior and posterior to the lateral malleolus, ascends the posterior aspect of the calf between the gastrocnemius and heads to the popliteal fossa.
  • In 60%, it drains into the deep popliteal vein at the sapheno-popliteal junction located within 5-7cm of the popliteal skin crease.
  • In the remaining, the SSV may drain into other veins such as the GSV or have several termination points.

Chronic Venous Insufficiency (CVI) and Varicose veins (VV)

Primary venous disease occurs as a result of focal or diffuse structural weakening of the vein wall. The exact nature and cause are not completely understood. Valvular incompetence in the superficial veins can occur due to disruption by thrombotic events, be congenitally absent, atretic or dysfunctional over time.

Chronic Venous Insufficiency, Varicose Vein and Management Options - Symptoms

Symptoms and complications from CVI may include:

  • Lower extremity pain
  • Swelling
  • Heaviness after prolonged standing

chronic venous insufficiency symptoms

Complications include:

  • Superficial thrombophlebitis
    chronic venous insufficiency complications
  • Acute bleeding in one of the thinned wall varices
  • Eczema
    chronic venous insufficiency (cvi) complications
  • Skin ulceration
    complications as a result of chronic venous insufficiency

Varicose veins are defined as “subcutaneous” veins in the lower extremities dilated to >3mm in diameter in the upright position. More often their appearance may be alarming but they are benign and treatment is sometimes done for aesthetic reasons.

Varicose veins benign

Chronic Venous Insufficiency, Varicose Vein and Management Options - How to prevent?

Chronic Venous Insufficiency, Varicose Vein and Management Options - Causes and Risk Factors

Chronic Venous Insufficiency, Varicose Vein and Management Options - Diagnosis

Venous Duplex ultrasound of standard study for evaluation. They map the superficial veins and identify the location and degrees of reflux.

venous duplex ultrasound

Chronic Venous Insufficiency, Varicose Vein and Management Options - Treatments

Treatment depends on patient choice, severity and fitness. Options include:

  • No treatment – not a life-threatening condition especially for varicose veins
  • Conservative – trial of compression stockings

In patients who are considering or unsure about surgery, a trial of compression treatment can be employed. Recommendations include:

  • (20-30mmHg) for C2- C4 disease of the CEAP classification
  • (30-40mmHg) compression therapy with garment for C6 ulcer disease

Most chronic discomfort and skin changes can be ameliorated by judicious use of compression garments, skin care, lifestyle changes and topical dressings.

Chronic Venous Insufficiency, Varicose Vein and Management Options - Preparing for surgery

Chronic Venous Insufficiency, Varicose Vein and Management Options - Post-surgery care

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