Chronic venous insufficiency is a common problem in the U.S., affecting approximately 5% of the general population. It is estimated that ½ million patients suffer from ulceration of the lower extremity as a result of longstanding venous disease.
An elaborate network of one-way valves normally prevents venous reflux into the lower extremity which can result in venous hypertension. Incompetence of this valvular system secondary to either dilatation (varicosity) or to previous deep vein thrombosis allows gravity to act on a longer column of fluid. The basic laws of physics predict an increase in venous pressure the longer the column of fluid becomes (the more valves impaired). In turn, venous hypertension is believed to be the underlying cause of all events that eventually lead to the sequelae of chronic venous insufficiency – leg edema (swelling), hyperpigmentation, varicose veins, and ulceration. The clinical features of chronic venous insufficiency may be subtle but are often evident to the experienced clinician. Duplex ultrasonography and standard phlebography (venography) are helpful in establishing the diagnosis and severity of venous insufficiency.