{ "schemaVersion": 2, "eyebrow": "Vascular Medicine", "title": "Venous Insufficiency", "summary": "Evaluate chronic venous disease with duplex ultrasound for reflux and obstruction, exclude arterial disease before compression, and match treatment to superficial reflux, deep obstruction, edema, skin injury, or active ulceration.", "seoDescription": "Physician guide to venous insufficiency: duplex evaluation, safe compression, ulcer management, and selection of endovenous treatment for reflux.", "clinicalQuestion": "How should clinicians evaluate and manage chronic venous insufficiency, including venous ulcers and symptomatic superficial reflux?", "specialty": "Vascular Medicine", "audience": "U.S. physicians and medical trainees", "tags": [ "chronic venous insufficiency", "chronic venous disease", "venous reflux", "venous leg ulcer", "duplex ultrasound", "compression therapy", "endovenous ablation", "CEAP" ], "keyTakeaways": [ "Use duplex ultrasound to define superficial or deep venous reflux and venous obstruction; obtain CT or MR venography when obstruction or a compressive syndrome is suspected. [4]", "Assess arterial perfusion before prescribing compression because compression pressures that exceed arterial pressures can cause serious harm. [12]", "For venous leg ulcers, compression and local wound care are foundational, but correction of superficial reflux reduces long-term ulcer recurrence. [16][17]", "Symptomatic superficial venous reflux can be treated with endovenous thermal ablation or ultrasound-guided foam sclerotherapy rather than conventional surgery in appropriately selected patients. [2][7]", "Document clinical severity longitudinally with CEAP and the Venous Clinical Severity Score rather than relying on visible varicosities alone. [4]" ], "sections": [ { "id": "triage-and-initial-phenotyping", "eyebrow": "First Visit", "heading": "Separate chronic venous disease from acute thrombosis, arterial disease, and nonvenous edema", "intro": "The first decision is whether chronic venous hypertension is the primary process and whether compression is safe.", "paragraphs": [ "Do not attribute unilateral new swelling, pain, or a rapid change in chronic symptoms to venous insufficiency without evaluating for acute venous thrombosis. Chronic venous disease may involve superficial, deep, or perforating venous dysfunction, and prior deep venous thrombosis can produce chronic outflow obstruction and valvular incompetence consistent with post-thrombotic disease. [8][18]", "Before initiating therapeutic compression, assess arterial perfusion clinically and obtain an ankle-brachial index when peripheral arterial disease is plausible. The key safety principle is that compression becomes hazardous when applied pressure exceeds arterial pressure; an abnormal or unreliable ABI should redirect management toward vascular assessment rather than empiric high-pressure compression. [12][4]", "Record CEAP class and Venous Clinical Severity Score (VCSS) at baseline when symptoms, edema, skin changes, or ulceration are present. These scales make progression and post-treatment response measurable, particularly when deciding whether persistent symptoms after compression warrant anatomic intervention. [4]" ], "bullets": [ "Escalate urgently for suspected acute DVT, limb-threatening ischemia, rapidly progressive ulcer infection, or marked new unilateral edema rather than treating as stable chronic venous disease.", "Treat edema as potentially multifactorial when the clinical distribution or course is discordant with the venous examination; venous testing should identify reflux or obstruction before invasive venous treatment. [4]" ], "subsections": [], "table": { "caption": "Clinical pattern and the next vascular decision. [4][8][12][18]", "columns": [ "Pattern", "Primary concern", "Next action" ], "rows": [ [ "New unilateral painful swelling", "Acute venous thrombosis may coexist with or mimic chronic venous disease. [18]", "Evaluate for acute DVT before assigning symptoms to chronic insufficiency." ], [ "Chronic edema with stasis skin change or ulcer", "Advanced chronic venous disease; determine reflux, obstruction, or both. [4]", "Obtain venous duplex ultrasound; assess arterial perfusion before compression. [4][12]" ], [ "Prior DVT with persistent swelling, pain, or skin disease", "Post-thrombotic valvular incompetence and/or venous outflow obstruction. [18]", "Use duplex ultrasound; pursue cross-sectional venography if central obstruction is suspected. [4]" ], [ "Suspected peripheral arterial disease", "Compression may compromise already limited arterial inflow. [12]", "Obtain ABI and modify compression strategy based on arterial assessment. [4][12]" ] ] } }, { "id": "duplex-directed-workup", "eyebrow": "Anatomic Diagnosis", "heading": "Use duplex findings to distinguish reflux from outflow obstruction", "intro": "The treatment target is the hemodynamic lesion, not the presence of visible varicosities.", "paragraphs": [ "Order lower-extremity venous duplex ultrasound in symptomatic chronic venous disease to evaluate both reflux and obstruction. The actionable output is a map of the superficial, deep, and perforating systems that identifies whether symptoms and skin injury are attributable to superficial axial reflux, deep-system disease, obstruction, or combined pathology. [4][8]", "Superficial reflux supports treatment directed at the incompetent superficial vein when symptoms, progressive skin changes, or ulcer disease persist despite conservative measures. Deep venous obstruction or suspected iliac/central compression changes the pathway: obtain CT venography or MR venography to define obstruction or compressive anatomy rather than proceeding directly to superficial ablation. [4]", "Plethysmography can help discern venous outflow obstruction when the clinical question remains unresolved after standard assessment. Its role is adjunctive; duplex ultrasound remains the core test for reflux and obstruction in routine chronic venous disease evaluation. [4]" ], "bullets": [ "Map reflux before any ablation, foam treatment, phlebectomy, or surgical procedure; postprocedure surveillance studies assess closure and complications with ultrasound. [14][15]", "Do not assume an ulcer is explained by superficial reflux alone when duplex suggests deep venous disease or obstruction; characterize both systems before selecting a definitive procedure. [4][18]" ], "subsections": [ { "heading": "When cross-sectional venography changes management", "paragraphs": [ "Use CT or MR venography when duplex findings or the clinical distribution suggest proximal venous outflow obstruction or a compressive syndrome. This distinguishes a patient who may need obstruction-focused evaluation from one whose principal actionable lesion is superficial reflux. [4]" ], "bullets": [] } ], "table": { "caption": "Duplex-directed etiologic branches in chronic venous disease. [4][8][18]", "columns": [ "Duplex or imaging pattern", "Likely disease branch", "Management implication" ], "rows": [ [ "Superficial venous reflux without evidence of obstruction", "Primary superficial venous insufficiency. [4]", "Continue compression-based symptom control and consider endovenous treatment for clinically important reflux. [1][2][7]" ], [ "Deep venous reflux or chronic post-thrombotic abnormalities", "Post-thrombotic chronic venous disease. [18]", "Use compression and calf-pump strategies; evaluate coexisting obstruction before superficial intervention. [1][4]" ], [ "Evidence suggesting venous outflow obstruction", "Obstructive or compressive venous disease. [4]", "Define proximal anatomy with CT or MR venography; avoid treating this as isolated superficial reflux. [4]" ], [ "Mixed superficial reflux and deep disease", "Combined reflux/obstruction physiology. [4][18]", "Individualize sequencing around the dominant lesion and ulcer or skin-risk burden." ] ] } }, { "id": "compression-and-calf-pump-management", "eyebrow": "Conservative Treatment", "heading": "Use compression as active therapy, with arterial safety screening and adherence planning", "intro": "Compression addresses venous hypertension but does not eliminate anatomic reflux or obstruction.", "paragraphs": [ "Compression therapy is central to chronic venous insufficiency management and may be delivered with graded compression stockings, multilayer bandaging, short-stretch bandaging, inelastic garments, or pneumatic pumps. Select the modality that the patient can apply reliably and that fits edema burden, limb shape, skin integrity, and ulcer status. [1][4]", "For substantial edema, dermatitis, or an active venous ulcer, multilayer or short-stretch bandaging can provide a practical initial approach; transition to a sustainable compression garment after edema and wound exudate permit. Ongoing adherence matters because continued compression is associated with prevention of venous ulcer recurrence. [4][22]", "Prescribe leg elevation and calf/foot flexion exercises as adjuncts to reduce venous hypertension and improve calf-muscle pump function. Structured exercise has been shown to improve calf pump function in chronic venous insufficiency; use this particularly when immobility or impaired ankle motion plausibly contributes to persistent edema. [1][18]" ], "bullets": [ "Reassess after compression initiation for ischemic symptoms, pressure injury, intolerance, and inability to don garments; these findings require a different device, application strategy, or arterial reassessment. [12]", "Treat stasis dermatitis with topical anti-inflammatory corticosteroid therapy when inflammation is present; use it alongside, not instead of, edema control and compression. [4]", "Use pneumatic compression as an available modality when garments or bandaging are insufficient or impractical, while continuing to evaluate the underlying reflux or obstruction pattern. [4]" ], "subsections": [], "table": { "caption": "Compression modalities and their practical role in chronic venous disease. [1][4][22]", "columns": [ "Modality", "Useful setting", "Key implementation issue" ], "rows": [ [ "Graded compression stockings", "Long-term management of symptoms and maintenance after edema control. [1][4]", "Adherence and ability to apply the garment determine effectiveness. [24]" ], [ "Multilayer bandaging", "Active venous ulceration or clinically important edema. [4][17]", "Requires ongoing reassessment as limb volume and wound drainage change." ], [ "Short-stretch or inelastic garments", "Management of chronic venous disease when a less elastic system is appropriate. [4]", "Confirm arterial safety before applying therapeutic compression. [12]" ], [ "Pneumatic compression pump", "Adjunctive edema management when other compression strategies are inadequate or impractical. [4]", "Does not replace evaluation for reflux or obstruction. [4]" ] ] } }, { "id": "venous-leg-ulcer-pathway", "eyebrow": "Ulcer Care", "heading": "Treat active venous leg ulcers with wound care, compression, and evaluation for reflux correction", "intro": "An active ulcer signals advanced disease and should trigger an anatomic venous assessment rather than compression alone.", "paragraphs": [ "For a suspected venous leg ulcer, document wound characteristics, evaluate arterial perfusion before compression, and obtain venous duplex ultrasound to identify superficial reflux, deep disease, and obstruction. Local wound care and compression are the basis of standard treatment, but the vascular workup identifies whether an intervention can reduce recurrence risk. [17][4][12]", "Compression alone can heal many chronic venous ulcers, and ongoing compliance reduces recurrence. However, in patients with correctable isolated superficial reflux, surgical correction reduced long-term recurrence in randomized evidence; this supports referral for evaluation of reflux treatment even when the wound is improving under compression. [22][3][16]", "Skin changes or active ulceration warrant venous specialist assessment for correction of underlying pathology when appropriate. The decision should be based on duplex-defined anatomy, arterial status, prior thrombosis, and the patient’s ability to maintain compression after wound healing. [16][4]" ], "bullets": [ "Do not defer duplex mapping solely because compression has begun; the result determines whether superficial reflux is a treatable recurrence driver. [4][16]", "If ulcer course is atypical, fails to follow a venous pattern, or arterial insufficiency is suspected, reassess the diagnosis rather than escalating compression empirically. [12][4]", "Continue recurrence prevention after healing with sustainable compression and correction of eligible superficial reflux. [22][16]" ], "subsections": [], "table": { "caption": "Venous leg ulcer decisions that change management. [3][4][12][16][17][22]", "columns": [ "Finding", "Interpretation", "Next step" ], "rows": [ [ "Ulcer with adequate arterial perfusion and venous disease features", "Venous hypertension is a treatment target. [12][17]", "Initiate compression plus local wound care and obtain venous duplex ultrasound. [4][17]" ], [ "Isolated superficial reflux on venous assessment", "A correctable reflux source may contribute to recurrence. [3][16]", "Evaluate for reflux correction in addition to compression. [16]" ], [ "Deep obstruction or compressive syndrome suspected", "Superficial reflux may not be the only hemodynamic lesion. [4]", "Obtain CT or MR venography to define obstruction before procedural planning. [4]" ], [ "Possible arterial insufficiency", "Therapeutic compression may be unsafe. [12]", "Perform arterial assessment and modify management before compression escalation. [4][12]" ] ] } }, { "id": "treatment-of-superficial-reflux", "eyebrow": "Definitive Treatment", "heading": "Select endovenous treatment for clinically important superficial venous reflux", "intro": "Procedures should target a duplex-confirmed refluxing superficial vein and a patient-centered outcome.", "paragraphs": [ "For symptomatic superficial venous reflux, endovenous thermal ablation and ultrasound-guided foam sclerotherapy are established alternatives to conventional surgery. In the randomized trial comparing treatment approaches for varicose veins, both foam sclerotherapy and thermal ablation were used as minimally invasive alternatives to surgery. [2]", "Endovenous laser ablation and radiofrequency ablation are established thermal options for great saphenous reflux; contemporary evidence describes great saphenous closure rates exceeding 90% with symptom relief and supports endovenous thermal ablation as first-line treatment for symptomatic varicose veins. [7] Procedure choice should incorporate venous anatomy, access feasibility, local expertise, expected recovery, and the need for treatment of tributaries.", "Conventional high ligation and stripping remains a surgical comparator but has largely been displaced by minimally invasive endovenous techniques. In comparative studies, endovenous approaches were associated with less early pain and faster return to daily activities than conventional surgery, while follow-up includes clinical review and ultrasound assessment for closure, recurrence, and complications such as thrombophlebitis or DVT. [14][5]" ], "bullets": [ "Use ultrasound guidance for foam sclerotherapy and for endovenous treatment planning. [2][14]", "Follow patients clinically and with ultrasound after endovenous treatment to assess target-vein closure and procedure-related complications. [14][15]", "For patients with ulceration or advanced skin disease, prioritize identification and correction of the underlying reflux pattern rather than treating cosmetic tributaries alone. [16][4]" ], "subsections": [ { "heading": "Choosing between thermal ablation and foam treatment", "paragraphs": [ "Both ultrasound-guided foam sclerotherapy and thermal ablation are minimally invasive options for superficial reflux. Thermal modalities such as radiofrequency and laser ablation are established approaches for great saphenous incompetence, whereas foam treatment provides an ultrasound-guided nonsurgical alternative; select the modality after duplex mapping and discussion of anatomic suitability and follow-up needs. [2][7]" ], "bullets": [] } ], "table": { "caption": "Procedural options for duplex-confirmed superficial venous reflux. [2][5][7][14][15]", "columns": [ "Approach", "Best-supported role from available evidence", "Follow-up focus" ], "rows": [ [ "Endovenous laser ablation", "Established thermal treatment for great saphenous insufficiency and symptomatic varicose veins. [7][14]", "Ultrasound assessment of target-vein closure; assess pain, thrombophlebitis, DVT, recurrence, and skin complications. [14][15]" ], [ "Radiofrequency ablation", "Established thermal option for superficial venous reflux; comparative reports describe lower early pain than surgical approaches. [5][7]", "Clinical and ultrasound surveillance for closure and complications. [14][15]" ], [ "Ultrasound-guided foam sclerotherapy", "Minimally invasive alternative to surgery evaluated for varicose veins. [2]", "Confirm treatment response and identify recurrent or residual reflux with ultrasound." ], [ "High ligation and stripping", "Conventional surgical option when endovenous approaches are unsuitable or unavailable. [14]", "Monitor postoperative pain, hematoma, infection, recurrence, and neovascularization. [14]" ] ] } }, { "id": "monitoring-and-escalation", "eyebrow": "Follow-up", "heading": "Monitor clinical severity, ulcer status, adherence, and anatomic treatment response", "intro": "Follow-up should detect treatment failure, recurrent reflux, missed obstruction, and compression-related harm.", "paragraphs": [ "At each follow-up, reassess symptoms, edema, skin inflammation, ulcer dimensions when present, compression tolerance, and VCSS or CEAP class. A worsening clinical score, recurrent ulceration, or persistent edema despite adherent compression should prompt review of the original duplex map and consideration of untreated superficial reflux, deep reflux, or outflow obstruction. [4][16][22]", "After endovenous treatment, use duplex ultrasound to document anatomic success, defined in endovenous reporting as absence of flow or disappearance of the treated target vein, and assess for complications and recurrence. Published protocols commonly include early ultrasound and serial clinical follow-up through months after treatment. [15][14]", "Recurrent or nonhealing ulcer disease requires renewed assessment of arterial adequacy and venous anatomy rather than indefinite escalation of dressings alone. Venous interventions that correct underlying insufficiency can reduce ulcer recurrence, while ongoing compression remains important after healing. [16][22]" ], "bullets": [ "Repeat or extend imaging when the clinical course no longer matches the original reflux-only diagnosis, especially after prior DVT or when proximal obstruction is suspected. [4][18]", "Use persistent ulceration, recurrent ulceration, progressive skin change, or inability to maintain compression as triggers for vascular re-evaluation. [16][22]", "Document postoperative complications specifically, including superficial thrombophlebitis, DVT, pigmentation, hematoma, infection, burn, and recurrence after thermal procedures. [14]" ], "subsections": [], "table": { "caption": "Follow-up triggers after conservative or procedural treatment. [4][14][15][16][22]", "columns": [ "Follow-up finding", "What it suggests", "Action" ], "rows": [ [ "Improving edema or ulcer with tolerable compression", "Current compression and wound strategy is effective. [22]", "Continue maintenance compression and complete venous reflux evaluation if not already performed. [4][16]" ], [ "Persistent symptoms despite adherent compression", "Residual superficial reflux, deep disease, obstruction, or nonvenous contributors may be present. [4]", "Review duplex findings and consider CT or MR venography when obstruction is suspected. [4]" ], [ "Recurrent ulcer after healing", "Ongoing venous hypertension or insufficient recurrence prevention. [3][22]", "Reassess reflux and obstruction; reinforce compression and evaluate correctable superficial reflux. [16]" ], [ "Post-ablation pain, swelling, or abnormal surveillance ultrasound", "Procedure-related complication or incomplete anatomic response. [14][15]", "Perform focused clinical and duplex evaluation for thrombophlebitis, DVT, closure status, and recurrence. [14]" ] ] } } ], "faq": [ { "question": "When should a patient with chronic venous insufficiency be referred for venous intervention?", "answer": "Refer when duplex ultrasound demonstrates clinically important superficial reflux in a patient with persistent symptoms, progressive skin changes, or active/recurrent venous ulceration despite compression-based management. Patients with suspected deep obstruction or compressive anatomy require CT or MR venography-directed evaluation rather than reflex superficial ablation. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Nonsurgical Management of Chronic Venous Insufficiency", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/pdf/10.1056/NEJMcp2310224", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "Nonsurgical management includes reducing central venous hypertension, compression therapy, leg elevation, and exercises involving calf and foot flexion and", "score": 0.6543875 }, { "number": 2, "title": "A Randomized Trial Comparing Treatments for Varicose Veins", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa1400781", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "Ultrasound-guided foam sclerotherapy and thermal ablation techniques have become widely used alternatives to surgery. Chronic Venous", "score": 0.37910303 }, { "number": 3, "title": "RESEARCH - The BMJ", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/bmj/early/2006/12/31/bmj.39216.542442.BE.full.pdf", "authors": "www.bmj.com", "host": "www.bmj.com", "snippet": "Surgical correction of isolated superficial venous reflux reduces long- term recurrence rate in chronic venous leg ulcers.Eur J Vasc Endovasc.", "score": 0.73596483 }, { "number": 4, "title": "2021 ACC/AHA/SVM/ACP Advanced Training Statement on Vascular Medicine (Revision of the 2004 ACC/ACP/SCAI/SVMB/SVS Clinical Competence Statement on Vascular Medicine and Catheter-Based Peripheral Vascular Interventions): A Report of the ACC Competency Management Committee", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2020.09.579", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Trainees should be able to classify severity using common scales such as the Venous Clinical Severity Scale (VCSS) and Clinical, Etiology, Anatomic, Pathophysiologic (CEAP) classification. Trainees should also be able to incorporate appropriate diagnostic tests, including duplex ultrasound to evalua", "score": 0.48630774 }, { "number": 5, "title": "Endovenous thermal ablation combined with foam sclerotherapy is a safe and effective method for the treatment of lower extremity varicose veins: a multicenter retrospective analysis | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-026-66990-4", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "foot venous pressure, coagulation parameters, complication rates, Venous Clinical Severity Score (VCSS), and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-20) scores were assessed and compared up to 12 months postoperatively. Both minimally invasive groups demonstrated superior p", "score": 0.5674818 }, { "number": 6, "title": "Comprehensive Management of Venous Leg Ulcers : International ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/01180626-202524020-00001", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Editorial. Venous leg ulcers (VLUs) are the leading chronic wounds in the lower extremities 1 and indicate a severe form of Chronic Venous Disease (CVD).", "score": 0.5437604 }, { "number": 7, "title": "Safety and efficacy of microwave versus laser... : International Journal of Surgery", "detail": "journals.lww.com", "url": "https://journals.lww.com/international-journal-of-surgery/_layouts/15/oaks.journals/downloadpdf.aspx?an=01279778-202602000-00128", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "## Introduction\n\nPrimary lower limb varicose veins (LLVVs), a prevalent chronic venous disorder affecting 20%–30% of adults globally, often manifests with symptoms such as itching, pigmentation, limb heaviness, and ulceration, severely impairing patients’ quality of life. Traditional surgical interv", "score": 0.47913864 }, { "number": 8, "title": "Chronic Venous Insufficiency in Pregnant Women : Indian Journal of Vascular and Endovascular Surgery", "detail": "journals.lww.com", "url": "https://journals.lww.com/ijvs/fulltext/2021/08030/chronic_venous_insufficiency_in_pregnant_women.6.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "12. Cornu-Thenard A, Boivin P, Baud JM, De Vincenzi I, Carpentier PH. Importance of the familial factor in varicose disease. Clinical study of 134 families J Dermatol Surg Oncol. 1994;20:318–26Cited HereFull TextCrossRefPubMedGoogle Scholar \n 13. Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frul", "score": 0.42090955 }, { "number": 9, "title": "Varicose veins : Surgery Oxford - Ovid", "detail": "journals.lww.com", "url": "https://journals.lww.com/01817248-202505000-00002", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Varicose veins are part of a spectrum of chronic venous disease, which is common and widely accepted as a significant cause of patient morbidity, distress and", "score": 0.40896168 }, { "number": 10, "title": "Abstracts for The European Society for Cardiovascular Surgery 55th ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/icvts/article/5/Supplement_1/S1/725713", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Methods: Patients with chronic venous insufficiency and venous leg ulcers, resistant to compression therapy, were selected for endovenous laser treatment", "score": 0.5614318 }, { "number": 11, "title": "Cost-effectiveness of treatments for superficial venous reflux in ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/bjsopen/article-pdf/2/4/203/35374047/bjs556.pdf", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "The study population was patients with a chronic venous ulcer who were eligible for either compression therapy or an interventional procedure.", "score": 0.5533369 }, { "number": 12, "title": "State-of-the-Art Treatment of Chronic Venous Disease", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/article-pdf/32/6/949/873785/32-6-949.pdf", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Compression therapy, critical in treating CVI, can have disastrous results if compression pressures exceed arterial pressures. Chronic leg ulcers, often", "score": 0.5492786 }, { "number": 13, "title": "Antithrombotic Therapy for VTE Disease - Chest Journal", "detail": "journal.chestnet.org", "url": "https://journal.chestnet.org/article/S0012-3692(12)60129-9/pdf", "authors": "journal.chestnet.org", "host": "journal.chestnet.org", "snippet": "This article addresses the treatment of VTE disease. preexisting leg ulcers, or signs of chronic venous insufficiency, a review of its use in", "score": 0.37168434 }, { "number": 14, "title": "[PDF] Endovenous laser ablation vs conventional surgery in the ...", "detail": "applications.emro.who.int", "url": "https://applications.emro.who.int/imemrf/116/Egypt-J-Surg-2020-39-3-731-737-eng.pdf", "authors": "applications.emro.who.int", "host": "applications.emro.who.int", "snippet": "Keywords: ablation, conventional surgery, endovenous laser, great saphenous vein Egyptian J Surgery 39:731–737 © 2020 The Egyptian Journal of Surgery 1110-1121 Introduction Chronic venous insufficiency of the lower limbs is one of the most common benign diseases with prevalence rates as high as 28–3", "score": 0.34389287 }, { "number": 15, "title": "[PDF] Mohammed Hatem - EKB Journal Management System", "detail": "applications.emro.who.int", "url": "https://applications.emro.who.int/imemrf/8/Ain-Shams-Med-J-2020-71-1-147-160-eng.pdf", "authors": "applications.emro.who.int", "host": "applications.emro.who.int", "snippet": "the study was based on \"Recommended reporting standards for endovenous ablation for the treatment of venous insufficiency in 2007 which was defined as a clinical outcome of importance to patients (relief of the dominant presenting symptom, venous ulcer healing, prevention of progression of chronic v", "score": 0.31605303 }, { "number": 16, "title": "[PDF] Global Template - ClinicalTrials.gov", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/54/NCT03257254/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "JR, Davies CE, Deacon J, Harvey K, Minor J, Sassano A, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004;363(9424):1854-9. 8 Gohel MS, Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, et al. Lo", "score": 0.75464433 }, { "number": 17, "title": "[PDF] Multicenter observational program VAP-PRO-C6 - ClinicalTrials.gov", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/66/NCT04757766/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "A.I., Bogachev V.Yu. Chronic venous diseases in the Russian Federation. Results of an international research program VEIN CONSULT. Flebologiya. 2010; 4 (3): 9-12. [in Russ.] 2. Savelyev V.S. Phlebology Moscow: 2001 [in Russ.] 3. Shevchenko Yu.L., Stoyko Yu.M. Fundamentals of Clinical Phlebology. Mos", "score": 0.5504388 }, { "number": 18, "title": "[PDF] Cover Page - ClinicalTrials.gov", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/29/NCT02148029/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "43.\nAraki CT, Back TL, Padberg FT, et al. The significance of calf muscle pump function in venous ulcera-tion. J Vasc Surg. Dec 1994;20(6):872-877; discussion 878-879.\n44.\nJohnson BF, Manzo RA, Bergelin RO, Strandness DE, Jr. Relationship between changes in the deep venous system and the development", "score": 0.54971373 }, { "number": 19, "title": "[PDF] Management of common health problems of drug users - IRIS", "detail": "iris.who.int", "url": "https://iris.who.int/bitstreams/e97ba910-52a7-4527-8fd7-2c91fe405d22/download", "authors": "iris.who.int", "host": "iris.who.int", "snippet": "Chronic venous insufficiency occurs due to chronic damage to the veins. Venous ulcers occur as a complication", "score": 0.46337196 }, { "number": 20, "title": "[PDF] Introduction - IRIS", "detail": "iris.who.int", "url": "https://iris.who.int/bitstreams/3d613749-d5e9-4286-96db-7b3abc5dfdbe/download", "authors": "iris.who.int", "host": "iris.who.int", "snippet": "Internally, for treatment of symptoms of chronic venous insufficiency, includ- ing pain, feeling of heaviness in the legs, nocturnal calf-muscle spasms, itching.", "score": 0.30628887 }, { "number": 21, "title": "Tissue remodelling and increased DNA damage in...", "detail": "journals.lww.com", "url": "https://journals.lww.com/00133587-202125160-00025", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Chronic Venous Disorders (CEAP) includes the full spectrum of morphologic and functional abnormalities of the venous system, from telangiectasies to venous", "score": 0.32646516 }, { "number": 22, "title": "Healing and recurrence rates following radiofrequency ablation of ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/ejos/_layouts/15/oaks.journals/downloadpdf.aspx?an=00767571-201433020-00007", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Compression therapy alone can lead to healing of chronic venous ulcer (CVU) in most patients, and continued compliance with compression prevents ulcer", "score": 0.24731465 }, { "number": 23, "title": "Global Epidemiology of Chronic Venous Disease : Annals of Surgery", "detail": "journals.lww.com", "url": "https://journals.lww.com/annalsofsurgery/fulltext/2021/12000/global_epidemiology_of_chronic_venous_disease__a.15.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Objective: To provide an updated estimate of the global prevalence of CVD and to comprehensively evaluate risk factors associated with this condition.", "score": 0.19260046 }, { "number": 24, "title": "Evaluation of Outcomes Following Endovenous Laser Therapy for ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/njom/_layouts/15/oaks.journals/downloadpdf.aspx?an=00133597-202407000-00010", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Chronic venous insufficiency (CVI) is a term. Compression stocking use is the cornerstone of treatment; however, compliance rates are low.", "score": 0.4877716 } ], "publishedAt": "2026-09-15T23:07:46.808570+00:00", "updatedAt": "2026-09-15T23:07:46.808570+00:00", "readingMinutes": 7, "slug": "venous-insufficiency" }