Superficial Venous Disease—An Updated Review

Abstract

Objectives

This review article provides an updated review of a relatively common pathology with various manifestations. Superficial venous diseases (SVD) are a broad spectrum of venous vascular disease that predominantly affects the body's lower extremities. The most serious manifestation of this disease includes varicose veins, chronic venous insufficiency, stasis dermatitis, venous ulcers, superficial venous thrombosis, reticular veins, and spider telangiectasias.

Methods

The anatomy, pathophysiology, and risk factors of SVD were discussed during this review. The risk factors for developing SVD were related to race, age, sex, lifestyle, and certain genetic conditions as well as comorbid deep venous thrombosis (DVT). Various classification systems were listed, focusing on the most common one – the Revised Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. The clinical features including history and physical examination findings elicited in SVD were outlined.

Discussion

Imaging modalities utilized in SVD were highlighted. Duplex ultrasound is the first line in evaluating SVD but MRI and CT venography, plethysmography, and conventional venography are feasible options in the event of an ambiguous venous duplex ultrasound study. Treatment options highlighted in this review ranged from conservative treatment with compression stockings, which could be primary or adjunctive to pharmacologic topical and systemic agents such as azelaic acid, diuretics, plant extracts, medical foods, NSAIDs, anticoagulants and skin substitutes for different stages of SVD. Interventional treatment modalities include thermal ablative techniques like radiofrequency ablations (RFA), endovenous laser ablation (EVLA), endovenous steam ablation (EVSA), and endovenous microwave ablation (EVMA) as well as non-thermal strategies such as the Varithena (Polidocanol microfoam) sclerotherapy, Venaseal (Cyanoacrylate) ablation and Endovenous mechanochemical ablation (MOCA). Surgical treatments are also available and include debridement, vein ligation, stripping, and skin grafting.

Conclusion

Superficial venous diseases (SVD) are prevalent and have varied manifestations predominantly in the lower extremities. Several studies highlight the growing clinical and financial burden of these diseases. This review provides an update on the pathophysiology, classification, clinical features, and imaging findings as well as the conservative, pharmacological, and interventional treatment options indicated for different SVD pathologies. It aims to expedite the timely deployment of therapies geared towards reducing the significant morbidity associated with SVD especially varicose veins, venous ulcers, and venous insufficiency, to improve the quality of life of these patients and prevent complications.