Diagnosis and management of chronic venous disorders

Skin changes, venous ulcers, and a past history of deep vein thrombosis may suggest venous reflux. Doppler ultrasonography appears to be the best method of investigation. Surgery is may be effective for patients with sapheno-femoral of sapheno-popliteal junction incompetence. Sclerotherapy may be effective in some patients with non-saphenous varicose veins.

A systematic review included 103 studies. 18 articles were on diagnostic tests, and 10 were on outcomes.

Diagnosis: Skin changes and venous ulcers are associated with the presence of venous reflux, a past history of deep venous thrombosis seems to be a good predictor of venous incompetence leading to ulceration. Clinical examination based on palpation of varicose veins has a low sensitivity but a high specificity for detecting superficial reflux. Doppler has a high sensitivity but low specificity in the detection of deep venous insufficiency, and is thus most useful as a screening test. A tourniquet may help differentiate superficial from deep vein reflux, but more data are needed to formally assess its validity. Duplex examination is the best available method, but its specificity is not optimal for a reference test.

Treatment of varicose veins: Symptoms associated with varicose veins can be relieved by medication and by gradual compression stockings. Sclerotherapy is effective for non-saphenous varicose veins, with reported treatment success of 70 - 80% at one year, but sometimes the cosmetic outcome is not good. Surgery is the treatment of choice for saphenous varicose veins. There is clear evidence of the effectiveness of surgery in patients with saphenofemoral junction or sapheno-popliteal junction reflux. Surgery is also indicated in patients without evidence of reflux in the large veins but with large tributaries feeding varicose veins.

Ədəbiyyat

1. Kurz X, Kahn SR, Abenhaim L, Clement D, Norgren L, Baccaglini U, Berard A, Cooke JP, Cornu-Thenard A, Depairon M, Dormandy JA, Durand-Zaleski I, Fowkes GR, Lamping DL, Partsch H, Scurr JH, Zuccarelli F. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. Int Angiol 1999 Jun;18(2):83-102.