From the Guidelines
Vascular surgeons, interventional radiologists, phlebologists, and some interventional cardiologists are the specialists who handle venous insufficiency, with vascular surgeons being the primary specialists. These specialists diagnose venous insufficiency through physical examination, ultrasound imaging, and sometimes venography to assess the extent of valve dysfunction and blood pooling in the legs 1. Treatment options range from conservative measures like compression stockings, leg elevation, and exercise to more advanced interventions such as sclerotherapy, endovenous laser treatment (EVLT), radiofrequency ablation, or surgical procedures like vein stripping for severe cases 1.
Key Considerations
- Patients should seek evaluation when experiencing symptoms like leg swelling, pain, heaviness, varicose veins, skin changes, or ulcers.
- Early intervention is important as venous insufficiency is progressive and can lead to complications like venous stasis ulcers if left untreated.
- Primary care physicians can provide initial assessment and referral to the appropriate specialist based on symptom severity and local availability of specialists.
Diagnosis and Treatment
- Ultrasound imaging is a painless and readily available modality that can assess the anatomy and physiology of the lower extremity venous system 1.
- The Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification system is used to categorize venous disease of the legs according to the severity, cause, site, and specific abnormality 1.
- Treatment of superficial venous insufficiency is intended to alleviate symptoms and reduce the risk of complications, with options including vein ablation using laser energy, radiofrequency-generated thermal energy, or chemical sclerosing agents 1.
From the Research
Specialists Handling Venous Insufficiency
The specialists who handle venous insufficiency include:
- Vascular surgeons, who perform surgical procedures such as removal of varicose veins, ablation of incompetent axial veins, and subfascial endoscopic perforator surgery (SEPS) 2, 3, 4, 5
- Phlebologists, who specialize in the diagnosis and treatment of venous disorders, including venous insufficiency 6
- Interventional radiologists, who perform minimally invasive procedures such as venous thermal ablation using laser or radiofrequency, and ultrasound-guided foam sclerotherapy 6
Treatment Approaches
The treatment approaches for venous insufficiency include:
- Surgical treatment, such as high ligation with stripping, radiofrequency ablation, endovenous laser therapy, and foam sclerotherapy 2, 3, 4, 5
- Endovascular therapy, such as percutaneous recanalization of post-thrombotic deep venous occlusions 5
- Minimally invasive alternative treatments, such as ultrasound-guided foam sclerotherapy 6
- Conservative management, including compression therapy, elevation of the extremities, and exercise 3, 4, 5