Varicose veins and associated chronic venous insufficiency (CVI) are among the most prevalent vascular disorders worldwide. Prevalence estimates vary considerably, ranging from 40% to 73% in women and 20% to 56% in men. Established risk factors include older age, female sex, obesity, pregnancy, a history of deep vein thrombosis, and prolonged standing. However, the relative contributions of genetic factors have not yet been fully elucidated. A genome-wide association study identified 855 nucleotide polymorphisms and 30 independent genetic variants associated with varicose veins.

Diagnostic Decisions

The clinical presentation of leg heaviness, edema, and skin changes often reflects years of disease progression. In primary care, distinguishing CVI from other causes of edema, such as heart failure or adverse effects of medications such as calcium-channel blockers, hormone therapy, and nonsteroidal anti-inflammatory drugs, is the first step. The study authors emphasized that a structured clinical examination supplemented by duplex ultrasonography forms the basis for every treatment decision. Identifying the refluxing segment is critical for selecting the appropriate compression class, according to the expert team.

Compression Cornerstone

Compression therapy remains the gold-standard treatment. Evidence shows that even a moderate pressure of 20-30 mm Hg provides significant relief in most individuals with uncomplicated CVI. Pressures > 30 mm Hg are recommended for ulcer healing but are difficult to tolerate. Caution is warranted in individuals with peripheral arterial disease and an ankle-brachial index < 0.8. In such cases, the arterial status must be assessed before initiating high-pressure compression, particularly at pressures > 30 mm Hg, to ensure that the limb retains adequate arterial perfusion. When a patient’s symptoms correlate with duplex ultrasonography findings, interventional procedures such as sclerotherapy or vein stripping may be justified to relieve symptoms and facilitate wound healing.

A critical issue, however, is adherence: Many individuals discontinue compression therapy because of difficulties in its application. The use of donning aids or a switch to low-pressure compression stockings may be helpful. In addition, weight reduction and targeted ankle exercises play a role that is frequently underestimated.

GPs should not wait for the development of venous leg ulcers before treating CVI. Early counselling on leg elevation and consistent skin care to prevent stasis dermatitis are essential. Pharmacologic options, such as venoactive agents, may provide supportive benefits in selected cases but do not replace mechanical support. Conservative management of CVI requires patient care and close follow-up. Well-informed patients have a significantly better quality of life and a lower risk for ulceration.

This story was translated from Coliquio, part of the Medscape Professional Network.