Venous Disease: “More Than Just a Cosmetic Issue”

Vineet Mishra, MD, presented, “Veins 101: Practical Tips and Tricks,” on the final day of Spring Dermatology Week 2023.

Dr Mishra is an adjunct associate professor of dermatology at the University of California-San Diego. His session’s objectives included understanding the venous pathology of reflux, reviewing key principles of sclerotherapy, and highlighting the importance of compression, with the goal of inspiring attendees to learn more about venous disease.

In the United States, venous disease affects 10% to 20% of adults, and 40% of these patients will develop deep vein thrombosis, thrombophlebitis, or ulcerations. Venous ulcers are responsible for more than $3 billion in treatment costs.

Because the superficial venous system is interconnected, treating different size vessels independently results in higher rates of treatment failure, pigmentation, and matting. Diagnosis should be made by venous reflux examination.

The spectrum of chronic venous disease includes varicose veins, lipodermatosclerosis, and venous ulcer. The clinical, etiological, anatomical, pathophysiological, or CEAP, classification can be used to determine the severity of venous disease. This should be done before considering treatment options.

Procedural treatments include surgery, sclerotherapy, laser, and radiofrequency. Endovenous ablation, an in-office procedure performed with tumescent anesthesia that allows for ambulation immediately following surgery, has minimal incisions, low risks, and a quick recovery time.

Conservative therapy should be considered before procedural treatment. This includes leg elevation, compression, exercise, and frequent movement of the lower extremities. Regarding compression therapy, anti-embolism stockings do not adequately compress in patients with superficial or deep venous disease and patients must be educated on how to properly don compression stockings.

Further testing should be done if the pattern of disease suggests venous disease or if the patient is experiencing heaviness, achiness, swelling, throbbing, or itching.

“Venous disease is more than just a cosmetic issue,” Dr Mishra emphasized.

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Reference

Mishra V. Veins 101: practical tips and tricks. Presented at: Dermatology Week; May 3–6; Virtual.