CHRONIC VENOUS INSUFFICIENCY AND VENOUS ULCERATION

OBJECTIVE: To review and summarize the literature on the normal venous circulation of the leg, and the epidemiology, pathophysiology, and tr eatment of chronic venous insufficiency (CVI). DATA SOURCES: English-l anguage articles identified through a MEDLINE search (1966-1996) using the terms venous insufficiency or varicose ulcer and epidemiology, pa thophysiology, diagnosis, and clinical trial (pt), and selected cross- references. STUDY SELECTION: Articles on epidemiology, pathophysiology , and treatment of CVI. Randomized, controlled studies were specifical ly sought for treatment efficacy. DATA EXTRACTION: Data were manually extracted from selected studies and reviews; emphasis was placed on in formation relevant to the general internist. DATA SYNTHESIS: Chronic v enous insufficiency is a common primary care problem associated with s ignificant morbidity and health care costs. The clinical spectrum of d isease ranges from minor cosmetic concerns to severe fibrosing pannicu litis 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 t reatments for CVI; recalcitrant cases may require intermittent pneumat ic compression. Topical antiseptics, antibiotics, enzymes, or growth f actors offer no clear advantages in ulcer healing, Ulcer dressings rem ain a matter of convenience, cost, and physician judgment. The role of surgery in CVI appears to be limited. CONCLUSIONS: Chronic venous ins ufficiency is a recalcitrant, recurrent medical problem. This conditio n can be managed by primary care physicians with relatively inexpensiv e treatment modalities in association with lifestyle modification.