Venous Insufficiency Guidelines - Medscape Reference

Guidelines Summary · C0 - No visible signs of venous disease · C1 - Telangiectases or reticular veins · C2 - Varicose veins · C3 - Edema without ... ForYou News&Perspective Drugs&Diseases CME&Education Academy Video DecisionPoint Edition: English Medscape English Deutsch Español Français Português UKNew Univadis LogIn SignUpIt'sFree! EnglishEdition Medscape English Deutsch Español Français Português UKNew Univadis X UnivadisfromMedscape Register LogIn NoResults NoResults ForYou News&Perspective Drugs&Diseases CME&Education Academy Video DecisionPoint close PleaseconfirmthatyouwouldliketologoutofMedscape. Ifyoulogout,youwillberequiredtoenteryourusernameandpasswordthenexttimeyouvisit. Logout Cancel https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA4NTQxMi1ndWlkZWxpbmVz processing.... Drugs&Diseases > Dermatology VenousInsufficiency Guidelines Updated:Sep25,2020 Author:RobertWeiss,MD;ChiefEditor:WilliamDJames,MD more... Share Email Print Feedback Close Facebook Twitter LinkedIn WhatsApp Sections VenousInsufficiency Sections VenousInsufficiency Overview Background Anatomy Pathophysiology Etiology Epidemiology Prognosis PatientEducation ShowAll Presentation History PhysicalExamination Complications ShowAll DDx Workup LaboratoryStudies Ultrasonography Venography VenousPlethysmography PhysiologicVenousFunctionTests AmbulatoryVenousPressureMonitoring ShowAll Treatment ApproachConsiderations GraduatedCompressionandOtherPhysicalModalities Venoablation Activity Prevention Implications ShowAll Guidelines Medication MedicationSummary SclerosingAgents ShowAll Questions&Answers MediaGallery References Guidelines GuidelinesSummary TheClinical,Etiology,Anatomic,Pathophysiology(CEAP)classificationwasdevelopedbyaninternationalconsensusconferencetoprovideuniformityinthereporting,diagnosing,andtreating CVI. [21] Clinicalclassificationisasfollows: C0-Novisiblesignsofvenousdisease C1-Telangiectasesorreticularveins C2-Varicoseveins C3-Edemawithoutskinchanges C4-Changesinskinandsubcutaneoustissue:A=Pigmentationoreczema;B=Lipodermatosclerosisoratrophieblanche C5-Healedulcer C6-Activeulcer Etiologicclassificationisasfollows: Congenital(ie,Klippel-Trenaunaysyndrome) Primary Secondary(ie,postthromboticsyndrome,trauma) Novenouscauseidentified Anatomicclassificationisasfollows: Superficial Deep Perforator Novenouslocationidentified Pathophysiologicclassificationisasfollows: Reflux Obstruction,thrombosis Refluxandobstruction Novenouspathophysiologyidentifiedinadvancedstages Medication     References RennerR,GebhardtC,SimonJC,SeikowskiK.Changesinqualityoflifeforpatientswithchronicvenousinsufficiency,presentorhealedlegulcers.JDtschDermatolGes.2009Nov.7(11):953-61.[QxMDMEDLINELink]. ZaniewskiM,SimkaM.Biophysicsofvenousreturnfromthebrainfromtheperspectiveofthepathophysiologyofchroniccerebrospinalvenousinsufficiency.RevRecentClinTrials.2012May.7(2):88-92.[QxMDMEDLINELink]. BryanLJ,CallasPW,CriquiMH,CushmanM.HighersolubleP-selectinisassociatedwithchronicvenousinsufficiency:theSanDiegoPopulationStudy.ThrombRes.2012Nov.130(5):716-9.[QxMDMEDLINELink]. CarrascoOF,RaneroA,HongE,VidrioH.Endothelialfunctionimpairmentinchronicvenousinsufficiency:effectofsomecardiovascularprotectantagents.Angiology.2009Dec-2010Jan.60(6):763-71.[QxMDMEDLINELink]. MaticM,MaticA,DjuranV,GajinovZ,PrcicS,GolusinZ.FrequencyofPeripheralArterialDiseaseinPatientsWithChronicVenousInsufficiency.IranRedCrescentMedJ.2016Jan.18(1):e20781.[QxMDMEDLINELink]. CoonWW,WillisPW3rd,KellerJB.VenousthromboembolismandothervenousdiseaseintheTecumsehcommunityhealthstudy.Circulation.1973Oct.48(4):839-46.[QxMDMEDLINELink]. PorterM.Acasestudyofvenouslegulceration.BrJCommunityNurs.2018Sep1.23(Sup9):S30-S36.[QxMDMEDLINELink]. Schultz-EhrenburgU,WeindorfN,MatthesU,HircheH.[Anepidemiologicstudyofthepathogenesisofvarices.TheBochumstudyI-III].Phlebologie.1992Nov-Dec.45(4):497-500.[QxMDMEDLINELink]. ChwałaM,SzczeklikW,SzczeklikM,Aleksiejew-KleszczyńskiT,Jagielska-ChwałaM.Varicoseveinsoflowerextremities,hemodynamicsandtreatmentmethods.AdvClinExpMed.2015Jan-Feb.24(1):5-14.[QxMDMEDLINELink]. ChiesaR,MaroneEM,LimoniC,VolonteM,SchaeferE,PetriniO.ChronicvenousinsufficiencyinItaly:the24-citiescohortstudy.EurJVascEndovascSurg.2005Oct.30(4):422-9.[QxMDMEDLINELink]. AbbadeLP,LastoriaS,RolloHdeA.Venousulcer:clinicalcharacteristicsandriskfactors.IntJDermatol.2011Apr.50(4):405-11.[QxMDMEDLINELink]. TsaiS,DubovoyA,WainessR.Severechronicvenousinsufficiency:magnitudeoftheproblemandconsequences.AnnVascSurg.2005.19:705-11. RacetteS,SauvageauA.Unusualsuddendeath:twocasereportsofhemorrhagebyruptureofvaricoseveins.AmJForensicMedPathol.2005Sep.26(3):294-6.[QxMDMEDLINELink]. EvansGA,EvansDM,SealRM,CravenJL.Spontaneousfatalhaemorrhagecausedbyvaricoseveins.Lancet.1973Dec15.2(7842):1359-61.[QxMDMEDLINELink]. CasianD,GutsuE,CuliucV.Surgicaltreatmentofseverechronicvenousinsufficiencycausedbypulsatilevaricoseveinsinapatientwithtricuspidregurgitation.Phlebology.2009Apr.24(2):79-81.[QxMDMEDLINELink]. GasparisAP,TsintzilonisS,LabropoulosN.Extraluminallipomawithcommonfemoralveinobstruction:acauseofchronicvenousinsufficiency.JVascSurg.2009Feb.49(2):486-90.[QxMDMEDLINELink]. BonnetblancJM.Legulcerations:aclinicalappraisal.EurJDermatol.2005May-Jun.15(3):127-32.[QxMDMEDLINELink]. Morales-CuencaG,Moreno-EgeaA,Aguayo-AlbasiniJL.[Generalsurgeonsandvaricoseveinsurgery].CirEsp.2009Apr.85(4):205-13.[QxMDMEDLINELink]. VandenBergPJ,VisserLH.Extra-andtranscranialechocolourDopplerinthediagnosisofchroniccerebrospinalvenousinsufficiency.Phlebology.2012Mar.27Suppl1:107-13.[QxMDMEDLINELink]. LattimerCR,AzzamM,KalodikiE,MakrisGC,GeroulakosG.Saphenouspulsationonduplexmaybeamarkerofseverechronicsuperficialvenousinsufficiency.JVascSurg.2012Nov.56(5):1338-43.[QxMDMEDLINELink]. EberhardtRT,RaffettoJD.Chronicvenousinsufficiency.Circulation.2014Jul22.130(4):333-46.[QxMDMEDLINELink]. LigiD,CroceL,MannelloF.ChronicVenousDisorders:TheDangerous,theGood,andtheDiverse.IntJMolSci.2018Aug28.19(9):[QxMDMEDLINELink]. [Guideline]GloviczkiP,ComerotaAJ,DalsingMC,etal.Thecareofpatientswithvaricoseveinsandassociatedchronicvenousdiseases:clinicalpracticeguidelinesoftheSocietyforVascularSurgeryandtheAmericanVenousForum.JVascSurg.2011May.53(5Suppl):2S-48S.[QxMDMEDLINELink]. ZhanHT,BushRL.Areviewofthecurrentmanagementandtreatmentoptionsforsuperficialvenousinsufficiency.WorldJSurg.2014Oct.38(10):2580-8.[QxMDMEDLINELink]. VanscheidtW,UkatA,PartschH.Dose-responseofcompressiontherapyforchronicvenousedema--higherpressuresareassociatedwithgreatervolumereduction:tworandomizedclinicalstudies.JVascSurg.2009Feb.49(2):395-402,402.e1.[QxMDMEDLINELink]. CouzanS,LeizoroviczA,LaporteS,etal.Arandomizeddouble-blindtrialofupwardprogressiveversusdegressivecompressivestockingsinpatientswithmoderatetoseverechronicvenousinsufficiency.JVascSurg.2012Nov.56(5):1344-1350.e1.[QxMDMEDLINELink]. Ramos-GonzalezE,Moreno-LorenzoC,Mataran-PenarrochaGA,Guisado-BarrilaoR,Aguilar-FerrandizME,Castro-SanchezAM.Comparativestudyontheeffectivenessofmyofascialreleasemanualtherapyandphysicaltherapyforvenousinsufficiencyinpostmenopausalwomen.ComplementTherMed.2012Oct.20(5):291-8.[QxMDMEDLINELink]. NijstenT,vandenBosRR,GoldmanMP,etal.Minimallyinvasivetechniquesinthetreatmentofsaphenousvaricoseveins.JAmAcadDermatol.2009Jan.60(1):110-9.[QxMDMEDLINELink]. ZimmetSE.Venouslegulcers:modernevaluationandmanagement.DermatolSurg.1999Mar.25(3):236-41.[QxMDMEDLINELink]. SadickNS.Advancesinthetreatmentofvaricoseveins:ambulatoryphlebectomy,foamsclerotherapy,endovascularlaser,andradiofrequencyclosure.DermatolClin.2005Jul.23(3):443-55,vi.[QxMDMEDLINELink]. NavarroTP,NunesTA,RibeiroAL,Castro-SilvaM.Istotalabolishmentofgreatsaphenousrefluxintheinvasivetreatmentofsuperficialchronicvenousinsufficiencyalwaysnecessary?.IntAngiol.2009Feb.28(1):4-11.[QxMDMEDLINELink]. MaksimovicZV,MaksimovicM,JadraninD,KuzmanovicI,AndonovicO.Medicamentoustreatmentofchronicvenousinsufficiencyusingsemisyntheticdiosmin--aprospectivestudy.ActaChirIugosl.2008.55(4):53-9.[QxMDMEDLINELink]. TretbarLL.Treatmentofsmallbleedingvaricoseveinswithinjectionsclerotherapy.Bleedingblueblebs.DermatolSurg.1996Jan.22(1):78-80.[QxMDMEDLINELink]. NaelR,RathbunS.Treatmentofvaricoseveins.CurrTreatOptionsCardiovascMed.2009Apr.11(2):91-103.[QxMDMEDLINELink]. LeopardiD,HogganBL,FitridgeRA,WoodruffPW,MaddernGJ.Systematicreviewoftreatmentsforvaricoseveins.AnnVascSurg.2009Mar.23(2):264-76.[QxMDMEDLINELink]. HusniEA.Reconstructionofveins:theneedforobjectivity.JCardiovascSurg(Torino).1983Sep-Oct.24(5):525-8.[QxMDMEDLINELink]. RajuS,NeglenP.Stentsforchronicvenousinsufficiency:why,where,howandwhen--areview.JMissStateMedAssoc.2008Jul.49(7):199-205.[QxMDMEDLINELink]. MediaGallery Superficialvenousinsufficiencywithskinchanges. Ulcerduetovenousinsufficiency. Venousvalve.Thrombosiscanbeginasbloodflowbecomesturbulent,permittingplateletstoremaininvalvesinus.Thisformsnidusofthrombus. Hemodynamicchartingof(a)healthypatients,(b)patientswithonlyvaricoseveins,(c)patientswithincompetentperforatorveins,and(d)patientswithdeepandperforatorincompetence. Perforatorveinbulgingintosubcutaneoustissue. Chronicvenousstasisulcer. Venousstasisulcerandsurroundingdystrophictissue. Venousinsufficiencyiliofemoralobstruction(Palmaoperation).Saphenousveinfromcontralaterallegtunneledsubcutaneouslytofemoralveinofaffectedlimb;cumulativepatencyof75%at5years.Procedurerelievesvenousclaudicationbutmaynothealulcersorrelieveswelling. Lower-legvenousanatomy. Perforatingveinsoflowerleg. Venogramdemonstratingincompetentperforatingveins. of 11 Tables BacktoList ContributorInformationandDisclosures Author RobertWeiss,MD AssociateProfessor,DepartmentofDermatology,JohnsHopkinsUniversitySchoolofMedicine RobertWeiss,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofCosmeticSurgery,AmericanAcademyofDermatology,AmericanCollegeofPhlebology,AmericanSocietyforDermatologicSurgery,AmericanSocietyforLaserMedicineandSurgery,MedChiTheMarylandStateMedicalSocietyDisclosure:ReceivedhonorariafromAngiodynamicsforspeakingandteaching;ReceivedintellectualpropertyrightsfromCoolTouchCorpforconsulting;Receivedgrant/researchfundsfromCynosureforindependentcontractor;Receivedgrant/researchfundsfromPalomarforindependentcontractor. Coauthor(s) DoraEIzaguirreAnariba,MD,MPH Physician,DepartmentofMedicine,WyckoffHeightsMedicalCenter DoraEIzaguirreAnariba,MD,MPHisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,AmericanHeartAssociation,AmericanMedicalAssociation,AmericanPublicHealthAssociation,ColegioMedicodeHondurasDisclosure:Nothingtodisclose. JesusLanza,MD FellowinPulmonaryandCriticalCareMedicine,DepartmentofMedicine,SectionofPulmonaryMedicine,LenoxHillHospitalDisclosure:Nothingtodisclose. Klaus-DieterLessnau,MD,FCCP FormerClinicalAssociateProfessorofMedicine,NewYorkUniversitySchoolofMedicine;MedicalDirector,PulmonaryPhysiologyLaboratory,DirectorofResearchinPulmonaryMedicine,DepartmentofMedicine,SectionofPulmonaryMedicine,LenoxHillHospital Klaus-DieterLessnau,MD,FCCPisamemberofthefollowingmedicalsocieties:AmericanCollegeofChestPhysicians,AmericanCollegeofPhysicians,AmericanMedicalAssociation,AmericanThoracicSociety,SocietyofCriticalCareMedicineDisclosure:Nothingtodisclose. ChiefEditor WilliamDJames,MD PaulRGrossProfessorofDermatology,Vice-Chairman,ResidencyProgramDirector,DepartmentofDermatology,UniversityofPennsylvaniaSchoolofMedicine WilliamDJames,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,SocietyforInvestigativeDermatologyDisclosure:Receivedincomeinanamountequaltoorgreaterthan$250from:Elsevier;WebMD
Servedasaspeakerforvariousuniversities,dermatologysocieties,anddermatologydepartments. Acknowledgements KatherineEBrown,DOConsultingStaff,DepartmentofSurgery,UniversityofCaliforniaatSanDiego Disclosure:Nothingtodisclose. MaryFarley,MDDermatologicSurgeon/MohsSurgeon,AnneArundelSurgeryCenter Disclosure:Nothingtodisclose. CraigFFeied,MD,FACEP,FAAEM,FACPhProfessorofEmergencyMedicine,GeorgetownUniversitySchoolofMedicine;GeneralManager,MicrosoftEnterpriseHealthSolutionsGroup Disclosure:Nothingtodisclose. WilliamHPearce,MDChief,DivisionofVascularSurgery,VioletandCharlesBaldwinProfessorofVascularSurgery,DepartmentofSurgery,NorthwesternUniversity,TheFeinbergSchoolofMedicine WilliamHPearce,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofSurgeons,AmericanHeartAssociation,AmericanSurgicalAssociation,AssociationforAcademicSurgery,AssociationofVASurgeons,CentralSurgicalAssociation,NewYorkAcademyofSciences,SocietyforVascularSurgery,SocietyofCriticalCareMedicine,SocietyofUniversitySurgeons,andWesternSurgicalAssociation Disclosure:Nothingtodisclose. YaleDPodnos,MD,MPHConsultingSurgeon,DepartmentofSurgery,CityofHopeNationalMedicalCenter Disclosure:Nothingtodisclose. VincentLopezRowe,MDAssociateProfessorofSurgery,DepartmentofSurgery,DivisionofVascularSurgery,UniversityofSouthernCaliforniaMedicalCenterProgramDirector,VascularSurgeryResidency VincentLopezRowe,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofSurgeons,AmericanHeartAssociation,PacificCoastSurgicalAssociation,PeripheralVascularSurgerySociety,SocietyforClinicalVascularSurgery,SocietyforVascularSurgery,andWesternVascularSurgicalSociety Disclosure:Nothingtodisclose. FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollegeofPharmacy;Editor-in-Chief,MedscapeDrugReference Disclosure:MedscapeSalaryEmployment RStanTaylor,MDTheJBHowellProfessorinMelanomaEducationandDetection,DepartmentsofDermatologyandPlasticSurgery,Director,SkinSurgeryandOncologyClinic,UniversityofTexasSouthwesternMedicalCenter RStanTaylor,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,AmericanCollegeofMohsSurgery,AmericanDermatologicalAssociation,AmericanMedicalAssociation,AmericanSocietyforDermatologicSurgery,ChristianMedical&DentalSociety,andSocietyforInvestigativeDermatology Disclosure:Nothingtodisclose. MichaelJWells,MDAssociateProfessor,DepartmentofDermatology,TexasTechUniversityHealthSciencesCenter,PaulLFosterSchoolofMedicine MichaelJWells,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanAcademyofDermatology,AmericanMedicalAssociation,andTexasMedicalAssociation Disclosure:Nothingtodisclose. Close Whatwouldyouliketoprint? Whatwouldyouliketoprint? Printthissection Printtheentirecontentsof Printtheentirecontentsofarticle Sections VenousInsufficiency Overview Background Anatomy Pathophysiology Etiology Epidemiology Prognosis PatientEducation ShowAll Presentation History PhysicalExamination Complications ShowAll DDx Workup LaboratoryStudies Ultrasonography Venography VenousPlethysmography PhysiologicVenousFunctionTests AmbulatoryVenousPressureMonitoring ShowAll Treatment ApproachConsiderations GraduatedCompressionandOtherPhysicalModalities Venoablation Activity Prevention Implications ShowAll Guidelines Medication MedicationSummary SclerosingAgents ShowAll Questions&Answers MediaGallery References FindUsOn About AboutMedscape PrivacyPolicy EditorialPolicy Cookies DoNotSellMyPersonalInformation TermsofUse AdvertisingPolicy HelpCenter Membership BecomeaMember AboutYou ProfessionalInformation Newsletters&Alerts Apps Medscape CME&Education WebMDNetwork MedscapeLiveEvents WebMD MedicineNet eMedicineHealth RxList WebMDCorporate Editions English Deutsch Español Français Português Allmaterialonthiswebsiteisprotectedbycopyright,Copyright©1994-2022byWebMDLLC.Thiswebsitealsocontainsmaterialcopyrightedby3rdparties. Close encodedsearchterm(VenousInsufficiency)andVenousInsufficiency WhattoReadNextonMedscape RelatedConditionsandDiseases DeepVenousThrombosis(DVT) DeepVenousThrombosisProphylaxisinOrthopedicSurgery AnticoagulationinDeepVenousThrombosis HeparinUseinDeepVenousThrombosis DeepVenousThrombosisRiskStratification ImaginginDeepVenousThrombosisoftheLowerExtremity PercutaneousTranscatheterTreatmentofDeepVenousThrombosis MedscapeConsult News&Perspective IBD-VTEScoreServesasRemindertoAssessPost-DischargeRisk PreoperativeLowerExtremityMotorWeaknessAffectsDeepVeinThrombosisDuringthePerioperativePeriodofLumbarSurgery DiagnosisandTreatmentofCellulitis:WhyCan'tWeGetItRight? Tools DrugInteractionChecker PillIdentifier Calculators Formulary Slideshow FallsintheElderly:Causes,Injuries,andManagement MostPopularArticles AccordingtoCardiologists FastFiveQuiz:TestYourKnowledgeonKeyAspectsofHeartFailure FastFiveQuiz:HeartFailureManagement Seizuresina42-Year-OldWhoLeftaHospitalAgainstAdvice FastFiveQuiz:CausesofHeartFailure ViewMore Recommended 20021911303-overviewDiseases&Conditions Diseases&Conditions DeepVenousThrombosis(DVT) 2003/viewarticle/958083ClinicalCase DiagnosingPulmonaryHypertensionandBestPracticesinCollaborativeCareWithExpertCenters 1.0CME/ABIMMOCCredits ClinicalCase Youarebeingredirectedto MedscapeEducation Yes,takemethere 1.0CME/ABIMMOC DiagnosingPulmonaryHypertensionandBestPracticesinCollaborativeCareWithExpertCenters 20021268573-overviewProcedures Procedures DeepVenousThrombosisProphylaxisinOrthopedicSurgery 20021927155-overviewDiseases&Conditions Diseases&Conditions HeparinUseinDeepVenousThrombosis NeedaCurbsideConsult? SharecasesandquestionswithPhysiciansonMedscapeconsult. Share aCase