Lower Extremity Varicose Veins

Publication Date: August 27, 2023

Key Points

Key Points

  • Varicose veins of the lower extremities are among the most frequent medical conditions affecting millions of people worldwide.
  • Chronic venous disease (CVD) may cause minimal symptoms, but varicose veins may often also be the source of discomfort, pain, swelling, thrombosis, bleeding and ulcerations, causing disability and a negative impact on physical, psychological, and social functioning components of quality of life.
  • Patients with chronic venous insufficiency (CVI) may progress to phlebolymphedema, skin changes with chronic inflammation, and venous leg ulcerations.

Diagnosis

...gnosis

...Evaluation of Patients With Varicose Veins

...Classification and grading of clinic...

...actice Statements...

...end the use of the 2020 updated Clinical Stag...

...ommend the use of the revised Venous Clinical...

...Doppler ultrasound scanning (DUS)

...commendatio...

...or patients with chronic venous dis...

...entation Remarks...

....1.Reflux is defined as a minimum value >500 ms...

...reflux of the GSV is defined as uninterrupted re...

...A definition of “pathologic” perforating ve...

...od Practice Statements

...1.We recommend that evaluation of reflux wit...

...mmend that for evaluation of reflux with DUS, th...

...recommend that a complete DUS examination...

....4.4.We recommend that a complete DUS...

1.4.5.We recommend that a complete...

...sus Statements...

...asymptomatic patients with telangiectasias...

...ymptomatic CEAP Class C1 patients with blee...

...atic patients with varicose veins (...

...atic patients with varicose veins (CEAP Class C2)...

...s with medial thigh or vulvar varicosities eva...


Treatment

...reatment

2. Compression The...

...1. Compression therapy vs. interv...

...commendations...

...1.1.For patients with symptomatic varic...

2.1.2.For patients with symptomatic varic...

...ts with symptomatic varicose veins and axial ref...

...patients with symptomatic varicose ve...

...ssion therapy after intervention...

...ents undergoing thermal ablation for saphenou...


...Pharmacological Treatment...

...ommendations...

...1.In symptomatic patients with varicose veins wh...

...ptomatic patients with varicose veins wh...


...  Interventions for Superficial Truncal Reflux...

...ous ablation vs. high ligation and stripping (...

...ommendatio...

4.1.1.For patients with symptomatic varico...

....2.For patients with symptomatic va...

...ients with symptomatic varicose veins and a...

...For patients with symptomatic varic...

...ents with symptomatic varicose veins and axial ref...

....For patients with symptomatic var...

...1.7.For patients with symptomatic v...

....1.8.For patients with symptomatic varicose...

.... Thermal vs. non-thermal ablation o...

...mmendations...

....2.1.For patients with symptomatic axi...

...ts with symptomatic axial reflux of the SSV, we re...

...ents with symptomatic axial reflux of the AA...


...ors Affecting Choice of Superficial Tru...

...ecommendati...

....In symptomatic patients with C2 dis...

...nsensus Statemen...

....In asymptomatic patients with C2 disease...

...Interventions to treat varicose veins can...

5.2.3.In patients with symptomatic C2...

...ients with symptomatic C2 disease, ablation of...

...nts with reflux in the below-knee GSV, abl...

...tients with an epifascial or superficial saphenous...

5.2.7.For patients with large (>10 mm), non-a...

...ence of superficial thrombophlebitis has be...

...2.9.In patients with uncomplicated C...


...erventions to Preserve the GSV

...mmendations...

6.1.1.For patients with the early s...

....1.2.For patients with symptomatic varicose...


...Treatment of Venous Tributaries...

7.1. Telangiectasias and reticul...

...ecommendat...

...1.1.For patients with symptomatic telangiectasi...

...atients with symptomatic telangiectasias...

7.2. Varicose tri...

...ommendations...

...atment of symptomatic varicose tributaries...

...ment of symptomatic varicose tributaries, we sugg...

...nsus Statement...

...ents with symptomatic varicose tributaries, tr...

...no clinical evidence that foam sclerotherapy usi...

...5.There is currently no clinical study of sclero...


...nt of Varicose Tributaries Concomit...

...mendations...

...1.For patients with symptomatic refl...

....For patients with symptomatic reflux in th...

...or patients with symptomatic reflux in the GSV or...

...4.For patients with symptomatic reflux...

...cal Practice Statement...

...ents with symptomatic reflux in the major supe...


...gement of Recurrent Varicosities...

...sus Statements...

...ts with symptomatic recurrent varicositie...

...r patients with symptomatic recurre...

...patients with symptomatic recurrent varic...

....1.4.For patients with symptomatic recurrent var...

....For patients with residual or recurre...


...Ablation of Incompetent Perforating Veins...

...mendations...

...ents with varicose veins (CEAP class C2) who...

...patients with varicose veins (CEAP class C2) wh...

...nsensus Statem...

...ents with incompetent pathologic perfor...


...Management of Ablation-related Thrombus Exten...

...Post-procedure DUS...

...ommendation...

...1.1.In an average-risk patient who is asy...

...sensus Statemen...

....2.In an average-risk patient who is...

....3.In a high-risk patient who is asy...

...mmendation...

....1.4.In patients who are symptomati...

11.2. Pharmacological throm...

...mmendation...

...risk patients undergoing endovenous...

...sus Statement

....For patients undergoing endovenous abl...

...of varicose vein procedure related...

Recommendations...

...ents with acute isolated distal DVT after varico...

...patients with isolated distal DVT...

...atients with acute proximal DVT after varicos...

...or patients with symptomatic ARTE...

...orsed the recommendations of Stevens...

...onsensus Statements

...1.For patients with asymptomatic ARTE...

...patients who receive anticoagulation for AR...


...Management of Superficial Vein Thrombosis (SVT)...

...mmendation 12 addresses the management...

...ommendation

...ents with SVT of the main saphenous trunks and tr...

...sensus Statemen...

12.1.2For patients with SVT of the main saph...

Recommendat...

...3.For patients with SVT of the main saph...

...selected patients with isolated throm...

...sus Statement...

...2.1.5.In patients with saphenous thrombo...


...t of Bleeding Varicose Veins...

...ensus Statements...

...3.1.For patients presenting with acute b...

...r patients with bleeding due to varicose veins,...

...ents who presented with bleeding f...

...ith varicose veins or venous ulceratio...


...Management of Superficial Vein Aneurys...

...onsensus Statemen...

...ts with superficial truncal vein aneurysm,...

...tients with an asymptomatic superficial truncal v...

...s with symptomatic, thrombosed or large (...


...vised VCSSHaving trouble viewing tab...


...ctive Drugs for CVDaHaving trouble viewing tabl...


...re 1. Anatomy of GSV and Its Tributarie...


.... Anatomy of SSV and Its Tributariesn., nerve; v....


...orating Veins of the LegPTV, posterior tib...