The prevalence of chronic venous disease (CVD) in the adult population has been reported to be as high as 60%,
particularly affecting populations in the developed world [1,2].
It has become clear that CVD is an important cause of patient distress and significantly impacts on healthcare resources [3,4].
Although a complete understanding of the pathophysiology of CVD remains elusive,
chronic venous hypertension is widely accepted as the predominant cause of advanced venous skin changes and ulceration.
Symptoms of CVD: extremely variable and cause significant morbidity to patients,
negatively impacting on quality of life (QoL) [5,6].
Self reported symptoms are worse in women [7,8].
These symptoms are:
- heaviness,
- tiredness,
- itching of the skin,
- nocturnal cramps,
- throbbing and aching of the legs [9].
Symptoms are exacerbated by prolonged standing and can interfere with day to day activities and work,
particularly in patients who need to stand for prolonged periods of time.
Symptoms are worse at the end of the day,
and symptomatic relief may be achieved by leg elevation,
mobilization,
and exercise.
In patients with chronic outflow obstruction,
venous claudication may typically occur during walking or climbing stairs.
The CEAP classification system was developed to take into account not only clinical (C) aspects of venous disease,
but also etiological (E),
anatomical (A),
and pathophysiological (P) components,
enabling a more comprehensive assessment of the severity of venous disease.
Treatment
A variety of treatment methods are currently available for patients with CVD:
- Compression therapy
- Medical therapy
- Surgery
- Endovenous thermal ablation techniques (radiofrequency,
laser)
- Sclerotherapy
- New endovenous non-thermal ablation techniques (cyanoacrylate)
Today,
in the treatment of varicose veins traditional endovenous thermal ablation techniques,
such as radiofrequency and laser,
are effective and widely in use.
However,
these techniques necessitate infiltration of tumescent anesthesia,
which can cause severe discomfort for the patient.
Bruising along the saphenous vein following thermal ablation,
arteriovenous fistula,
pseudoaneurysm formation,
and neurological complications causing paresthesia are other potential side effects.
A recent nonthermal,
non-tumescent methods is cyanoacrylate ablation: this technique don't use thermal energy,
obviating tumescent anesthesia and,
as a result it is better tolerated by patients.
Also the potential for nerve damage is minimal.