Alguire PC, Mathes BM.
Chronic venous insufficiency and venous ulceration.
J Gen Intern Med 1997 Jun;12(6):374-83

Division of Internal Medicine, University of Florida, Gainesville, USA.

OBJECTIVE: To review and summarize the literature on the normal venous
circulation of the leg, and the epidemiology, pathophysiology, and treatment of
chronic venous insufficiency (CVI). DATA SOURCES: English-language articles
identified through a MEDLINE search (1966-1996) using the terms venous
insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and
clinical trial (pt), and selected cross-references. STUDY SELECTION: Articles on
epidemiology, pathophysiology, and treatment of CVI. Randomized, controlled
studies were specifically sought for treatment efficacy. DATA EXTRACTION: Data
were manually extracted from selected studies and reviews: emphasis was placed on
information relevant to the general internist. DATA SYNTHESIS: Chronic venous
insufficiency is a common primary care problem associated with significant
morbidity and health care costs. The clinical spectrum of disease ranges from
minor cosmetic concerns to severe fibrosing panniculitis and ulceration. Duplex
Doppler ultrasonography may be the single best test to rule out deep venous
thrombosis and other entities that can mimic CVI. Leg elevation and compression
stockings are effective treatments for CVI; recalcitrant cases may require
intermittent pneumatic compression. Topical antiseptics, antibiotics, enzymes, or
growth factors offer no clear advantages in ulcer healing. Ulcer dressings remain
a matter of convenience, cost, and physician judgment. The role of surgery in CVI
appears to be limited. CONCLUSIONS: Chronic venous insufficiency is a
recalcitrant, recurrent medical problem. This condition can be managed by primary
care physicians with relatively inexpensive treatment modalities in association
with lifestyle modification.