Version June 2024
The algorithm describes the approach to managing superficial venous insufficiency associated with skin changes or VLU (CEAP 4 to 6). Superficial venous insufficiency can affect the superficial axial veins, which includes the GSV, SSV, and AASV, as well as nonaxial veins (eg, intersaphenous veins) or perforator veins. Treating the axial veins may be sufficient to reduce/relieve symptoms and heal VLU and is performed before treating nonaxial veins.
Refer to UpToDate topics on the management of chronic venous disease for additional details on our approach to treatment and the overall efficacy of these treatments.CEAP: Clinical-Etiology-Anatomy-Pathophysiology; VLU: venous leg ulcer; GSV: great saphenous vein; SSV: small saphenous vein; AASV: anterior accessory saphenous vein; MOCA: mechanochemical ablation; CAC: cyanoacrylate adhesive closure.
* Axial venous reflux is defined as retrograde flow ≥0.5 seconds duration in the GSV, SSV, or AASV.
¶ Conservative care includes limb elevation, compression therapy, limb exercises, lifestyle modification (eg, avoidance of prolonged standing/sitting), skin care, and VLU care.
Δ Typically medially located skin changes/VLU are a result of GSV reflux, while laterally located skin changes/VLU are the result of SSV reflux.
◊ Most ablation techniques can be used at any site; however, success rates and the nature and frequency of complications differ for various thermal and nonthermal ablation methods.
§ Thermal ablation includes radiofrequency ablation and endovenous laser ablation.
¥ Nonthermal ablation includes sclerotherapy (liquid, foam), MOCA, and CAC.
‡ While thermal or nonthermal options are preferred, if these are not an option, surgical ablation such as open ligation, division, stripping can be performed.
† Evaluate for recanalization, which is common following nonthermal ablation methods, particularly sclerotherapy.
** Residual varicose veins may, on occasion, contribute to skin changes or VLU and can be treated with ambulatory phlebectomy or thermal/nonthermal ablation.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
