Chronic venous insufficiency

Chronic venous disease is an important source of morbidity in Western Europe and the USA. Venous insufficiency is most often associated with great saphenous vein (GSV) reflux, but can also be present in the small saphenous vein (SSV) or perforator veins. Historically, the treatment has been surgery, with high ligation and stripping, combined with phlebectomies. Such treatment efficiently reduces symptoms, improves quality of life (QOL), and reduces the rate of reoperation. Sedentary work and prolonged standing at work are independent risk factors for development of venous insufficiency. Several theories have been proposed for the causal basis of chronic venous insufficiency (CVI). There are two universally accepted theories: primary valvular incompetence and primary congenital vein wall weakness. The main clinical features of CVI are leg pain, leg edema, varicose veins, and cutaneous changes. Endovascular therapy in the treatment of CVI has become increasingly important to restore outflow of the venous system and provide relief of obstruction.