Chronic Venous disease is a spectrum of conditions affecting the vascular system of the lower extremities.  This can include venous insufficiency, venous reflux, and venous dilation.  The essential underlying cause of this condition falls on venous hypertension.  This differs in that the venous system was not designed to carry a high pressure load.  Venous hypertension can occur by poor muscle pump action, incompetent valves causing reflux, and venous thrombosis or obstruction.  This increase in pressure can result in a myriad of complications from the simple and benign to the more serious.

Risk factors are varied.  Most venous disease occurs in populations of advancing age, previous family history, prolonged standing, obesity, high estrogen states, and pregnancy, smoking, lower extremity trauma with prior venous thrombosis , sedentary lifestyle,  high estrogen states, and pregnancy.  Some people have a congenital absence of venous valves leading to the underlying cause. The estimate of fifty percent involvement in the population is probably accurate.

Common problem categories:

1.  Telangiectasias (spider veins) – these probably rank highest in the variety of venous disease prevalence.  Telangiectasias are dilated intradermal and subdermal veins.  While these are the least severe of the venous problems, they can cause both psychological and physical symptoms.  These include depression, embarrassment and avoidance.  Physically there can be aching, burning, fatigue and swelling.  Rarely is there more serious concerns of ulceration or skin breakdown.   Treatment of this problem can range from simple to complex.  The conservative treatment includes exercise, elevation and compression.  Surgical treatment includes injectable sclerotherapy or laser treatment.  These treatments have mixed results and the problem can recur.
2. Vascular dilation (varicose veins) – Varicose veins are dilated, tortuous veins greater than 3mm in diameter.  Depending on the region and population, they can affect male and female with equal frequency.  These abnormalities occur most commonly in the lower extremities but can occur in the genital region of females.  This occurs due to the increased blood flow in pregnancy with the resultant obstruction from the growing fetus.   Treatment options include surgical excision or ablation of the offending vessel.
3. Chronic venous insufficiency – Advancing stages of insufficiency cause worsening problems.  These include edema, skin color and texture changes and ulceration/skin breakdown.  The ulceration can develop into non-healing wounds.  Venous ulcers are difficult to treat and sometimes impossible to heal.  The basics of treatment are supportive with compression and elevation being a mainstay.  Proper skin hygiene is of utmost importance with hydration (lotions, emollients) to help prevent breakdown.  Diuretics (water pills) show no benefit in reducing the swelling/edema associated with this process.  Once ulceration occurs, basic wound care with cleansing and debridement is necessary.  Topical solutions may be of benefit.