eMedicine Specialties > Vascular Surgery > Medical Topics

Chronic Venous Insufficiency: Follow-up

Author: Katherine E Brown, DO, Consulting Staff, Department of Surgery, University of California at San Diego
Contributor Information and Disclosures

Updated: May 11, 2009

Outcome and Prognosis

Hematoma, sural or saphenous nerve damage, and infection are possible complications of lower-extremity vein ligation.

Clot lysis (eg, TPA, urokinase) and thrombectomy have been tried but generally have been abandoned due to extremely high recurrence rates.

For iliofemoral disease, the operation of choice is a saphenous vein crossover graft. Due to a relatively high failure rate of 20%, ringed PTFE grafts are being used. The long-term patency is unknown.

The Husni bypass for superficial femoral vein occlusion is performed infrequently due to the high failure rate (approximately 40%).

Surgery for CVI resulting from deep vein incompetence includes valvuloplasty and allograft or cadaveric vein transplant. Valvuloplasty for patients with congenital absence of functional valves, when combined with the ligation of perforating veins, has a superior outcome in 80% of cases after 5 years. Allograft or cadaveric vein transplants are being tested, with long-term results pending.

Tsai et al examined the National Inpatient Sample from 1988-2000 and found that mean hospital charges were $13,900 and did not change over the time period examined.15 They also found that deep venous thrombosis affected 1.3% of patients and amputation was necessary in 1.2%, with an overall mortality of 1.6%.

Future and Controversies

Subfascial endoscopic perforator surgery (SEPS) is gaining in popularity as a means of treating CVI. Endoscopic techniques are used to find and ligate perforating veins. Preliminary reports are encouraging. The 1997 North American Subfascial Endoscopic Perforator Surgery Registry showed that after SEPS, the average healing time for ulcers was 42 days, with a recurrence rate of 3%. Ulcers treated with SEPS heal 4 times faster than ulcers treated conventionally. In addition, morbidity of SEPS is significantly lower than traditional operations. Long-term results are pending.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Yale D Podnos, MD, MPH, to the development and writing of this article.



More on Chronic Venous Insufficiency

Overview: Chronic Venous Insufficiency
Workup: Chronic Venous Insufficiency
Treatment: Chronic Venous Insufficiency
Follow-up: Chronic Venous Insufficiency
Multimedia: Chronic Venous Insufficiency
References
Further Reading
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References

  1. Homans J. The etiology and treatment of varicose ulcers of the leg. Surg Gynecol Obstet. 1917;24:300-11.

  2. Piulacks P. Pathogenic study of varicose veins. Angiology. 1953;4:59-100.

  3. Burnand KG, Whimster I, Naidoo A. Pericapillary fibrin in the ulcer-bearing skin of the leg: the cause of lipodermatosclerosis and venous ulceration. Br Med J (Clin Res Ed). Oct 16 1982;285(6348):1071-2. [Medline].

  4. Coleridge Smith PD, Thomas P, Scurr JH. Causes of venous ulceration: a new hypothesis. Br Med J (Clin Res Ed). Jun 18 1988;296(6638):1726-7. [Medline].

  5. Renner R, Gebhardt C, Simon JC, Seikowski K. Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcers. J Dtsch Dermatol Ges. Apr 6 2009;[Medline].

  6. Carrasco OF, Ranero A, Hong E, Vidrio H. Endothelial Function Impairment in Chronic Venous Insufficiency: Effect of Some Cardiovascular Protectant Agents. Angiology. Feb 23 2009;[Medline].

  7. Morales-Cuenca G, Moreno-Egea A, Aguayo-Albasini JL. [General surgeons and varicose vein surgery.]. Cir Esp. Apr 2009;85(4):205-13. [Medline].

  8. Casian D, Gutsu E, Culiuc V. Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation. Phlebology. 2009;24(2):79-81. [Medline].

  9. Gasparis AP, Tsintzilonis S, Labropoulos N. Extraluminal lipoma with common femoral vein obstruction: a cause of chronic venous insufficiency. J Vasc Surg. Feb 2009;49(2):486-90. [Medline].

  10. Navarro TP, Nunes TA, Ribeiro AL, Castro-Silva M. Is total abolishment of great saphenous reflux in the invasive treatment of superficial chronic venous insufficiency always necessary?. Int Angiol. Feb 2009;28(1):4-11. [Medline].

  11. Vanscheidt W, Ukat A, Partsch H. Dose-response of compression therapy for chronic venous edema--higher pressures are associated with greater volume reduction: two randomized clinical studies. J Vasc Surg. Feb 2009;49(2):395-402, 402.e1. [Medline].

  12. Maksimovic ZV, Maksimovic M, Jadranin D, Kuzmanovic I, Andonovic O. Medicamentous treatment of chronic venous insufficiency using semisynthetic diosmin--a prospective study. Acta Chir Iugosl. 2008;55(4):53-9. [Medline].

  13. Husni EA. Reconstruction of veins: the need for objectivity. J Cardiovasc Surg (Torino). Sep-Oct 1983;24(5):525-8. [Medline].

  14. Raju S, Neglén P. Stents for chronic venous insufficiency: why, where, how and when--a review. J Miss State Med Assoc. Jul 2008;49(7):199-205. [Medline].

  15. Tsai S, Dubovoy A, Wainess R. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg. 2005;19:705-11.

  16. Brand FN, Dannenberg AL, Abbott RD. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med. Mar-Apr 1988;4(2):96-101. [Medline].

  17. Elder DM, Greer KE. Venous disease: how to heal and prevent chronic leg ulcers. Geriatrics. Aug 1995;50(8):30-6. [Medline].

  18. Gloviczki P, Bergan JJ, Menawat SS. Safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery: a preliminary report from the North American registry. J Vasc Surg. Jan 1997;25(1):94-105. [Medline].

  19. Ibrahim S, MacPherson DR, Goldhaber SZ. Chronic venous insufficiency: mechanisms and management. Am Heart J. Oct 1996;132(4):856-60. [Medline].

  20. Martinez MJ, Bonfill X, Moreno RM. Phlebotronic for venous insufficiency. Cochrane database of Systematic Reviews. 2005;3.

  21. Neglen P, Raju S. A comparison between descending phlebography and duplex Doppler investigation in the evaluation of reflux in chronic venous insufficiency: a challenge to phlebography as the "gold standard". J Vasc Surg. Nov 1992;16(5):687-93. [Medline].

  22. Nyhus LIM, Barker RB, eds. Mastery of Surgery. 2nd ed. Boston, Mass: Little Brown; 1992:. 2133-9.

  23. Puggioni A, Kalra M, Gloviczki P. Superficial vein surgery and SEPS for chronic venous insufficiency. Seminars Vasc Surg. 2005;18:41-8.

  24. Weiss VJ, Surowiec SM, Lumsden AB. Surgical management of chronic venous insufficiency. Ann Vasc Surg. Sep 1998;12(5):504-8. [Medline].

  25. Wilson SE, Veith FJ, Williams RA. Chronic Venous Insufficiency. Vascular Surgery: Principles and Practice. 1978;723-61.

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Further Reading

Clinical guidelines

Leg ulcer guidelines: a pocket guide for practice.
Smith and Nephew, Ltd. - Private For Profit Organization.  2002 (revised 2006 Jan).  39 pages.  NGC:005254

Summary algorithm for venous ulcer care with annotations of available evidence.
Association for the Advancement of Wound Care - Private Nonprofit Organization.  2005.  25 pages.  NGC:004280

Guideline for management of wounds in patients with lower-extremity venous disease.
Wound, Ostomy, and Continence Nurses Society - Professional Association.  2005.  42 pages.  NGC:004431

Clinical trials

 Assess the Efficacy and Tolerability of Antistax Film-Coated Tablets in Patients With Chronic Venous Insufficiency

THERMES ET VEINES: Spa for Prevention of Leg Ulcers

A New Method of Surgically Treating Varicose Veins and Venous Ulcers - a Study to Assess Clinical and Economic Value

Related eMedicine topics

 Stasis Dermatitis

Deep Venous Thrombosis

Deep Venous Thrombosis and Thrombophlebitis

Varicose Veins

Venous Insufficiency

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Keywords

chronic venous insufficiency, CVI, superficial venous insufficiency, venous insufficiency, postphlebitic syndrome, postthrombotic syndrome lipodermatosclerosis, superficial venous incompetence, venous incompetence, valvular incompetence, hypercoagulability, Virchow triad, venous stasis, venous stasis ulcers, venous reflux, stasis dermatitis, stasis ulcer, venous ulcer, DVT, deep vein thrombosis, varicose veins, junctional high-pressure disease, perforator high-pressure disease, venous hypertension, varicosities, varicosity, telangiectasia, venectasia, spider vein, vein disease, venous disease, swollen veins, telangiectatic veins

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Contributor Information and Disclosures

Author

Katherine E Brown, DO, Consulting Staff, Department of Surgery, University of California at San Diego
Disclosure: Nothing to disclose.

Medical Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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