DISEASE EDUCATION SUPERFICIAL VEIN THERAPIES

Information about chronic venous insufficiency

CHRONIC VENOUS INSUFFICIENCY

Chronic venous insufficiency (CVI) is a progressive medical condition that may worsen over time and affects the veins and vessels in the leg that carry oxygen-poor blood back toward the heart. Signs and symptoms may include pain, swelling and fatigue of the legs, as well as skin damage and ulcers. CVI is often preceded by varicose veins.¹

Signs and Symptoms2

  • Varicose veins
  • Aching or pain
  • Swelling
  • Cramping
  • Heaviness or tiredness
  • Itching
  • Restlessness
  • Skin changes
  • Brown, colored skin
  • Open sores or ulcers

Risk Factors2

  • Family history
  • Lack of exercise
  • Leg injury or trauma
  • Prolonged sitting or standing
  • Obesity or excess weight
  • Current or previous pregnancies
  • Smoking

With proper treatment, the progressive symptoms of chronic venous insufficiency are preventable.

Without treatment, signs and symptoms may progress and significantly impact quality of life, and lead to venous leg ulcers.

VENOUS LEG ULCERS

Leg Ulcer Sources

A CLINICAL CHALLENGE

Treating patients with venous ulcers is not easy. It is important to not only treat the wound but also identify the cause — enabling your patients to live without the discomfort of these wounds.

  • 70% – 90% of all lower extremity ulcers are venous.3,4
  • 1 million people in the U.S. are affected by venous leg ulcers.3,4
  • More than half of venous ulcers treated are recurrent ulcerations.5

Superficial venous reflux is usually present in patients with venous leg ulcers ― yet many venous ulcer patients worldwide go unassessed or untreated for superficial venous reflux.3,6-8

LIVING WITH VENOUS LEG ULCERS COMPROMISES QUALITY OF LIFE

Due to pain, mobility limitations, and other consequences, venous leg ulcers have a significant impact on patients.9-11

Venous Leg Ulcers Depression and Quality of Life Impact

COST OF CARE

  • $15 billion spent by U.S. payers in managing VLU patients.4
  • $6,500 more  spent annually to treat VLU patients than others.4

EARLY ENDOVENOUS ABLATION TREATMENT MATTERS

THE EVRA STUDY: A Randomized Trial of Early Endovenous Ablation in Venous Ulceration

Early endovenous ablation of superficial venous reflux with compression therapy resulted in shorter time to ulcer healing compared to compression therapy alone.7

evra study key results7

EVRA Study Results

EVRA STUDY KEY FINDINGS7

EVRA Study Key Findings

LOOK UP. GO BEYOND THE WOUND.

FIND CVI IN YOUR VENOUS LEG ULCER PATIENTS

Venous leg ulcers may be caused by chronic venous insufficiency (CVI) due to reflux in any of the venous systems — superficial, perforator, or deep — when the valves of the veins have failed or the vein has become obstructed.12,13

Steps to Find and Treat Chronic Venous Insufficiency in Venous Leg Ulcer Patients

STEP 1: DIFFERENTIATE ARTERIAL ULCER FROM VENOUS ULCER

Ulcer appearance together with the medical history and physical exam should be used to determine the differential diagnosis and see if a venous leg ulcer is suspected.

Arterial Ulcer

Arterial Ulcer

Venous Ulcer

Venous Ulcer

CHARACTERISTIC ARTERIAL ULCER VENOUS ULCER

Location

Toes or foot

Malleolus or metatarsal

Appearance

Irregular margin,
cool cyanotic

Typically sloped edges, may have exudate, irregular shape

Foot temperature

Cold

Warm

Pain

Usually severe

Mild

Sensation

Variable, often decreased

Present, variable
(pain, temperature)

 

Arterial Pulses

Absent

Present, variable
(pain, temperature)

Veins

Collapsed

Dilated, varicosities, edema

STEP 2: IDENTIFY VENOUS REFLUX

Comprehensive Venous Duplex Ultrasound Examination of the lower extremity should be performed in all patients with a suspected venous leg ulcer in order to identify the cause and help determine the right treatment. The Society of Vascular Surgery (SVS) and the American Venous Forum (AVF) 2014 venous leg ulcer guidelines provide a strong recommendation for conducting this exam.3

STEP 3: TREAT WITH EARLY ENDOVENOUS ABLATION AND COMPRESSION

Our comprehensive toolkit empowers you to select the best approach for each patient. 

1

Eberhardt, R., Raffetto, J. Chronic Venous Insufficiency. Circulation. 2005;111:2398-2409.

2

Johns Hopkins Medicine Health Conditions and Diseases. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-venous-insufficiency. Accessed May 14, 2019.

3

O’Donnell TF Jr, Passman MA, Marston WA, et al. Management of venous leg ulcers: Clinical Practice Guidelines of the Society for Vascular Surgery® and the American Venous Forum. J Vasc. Surg. August 2014;60(2 Suppl):3S-59S.

4

Rice JB, Desai U, Cummings AK, Birnbaum HG, Skornicki M, Parsons N. Burden of venous leg ulcers in the United States. J Med Econ. May 2014;17(5):347-356.

5

Outpatient Wound Clinic Market Performance Report. Net Health Analytics. October 2013.

6

Adam DJ, Naik J, Hartshorne T, Bello M, London NJ. The diagnosis and management of 689 chronic leg ulcers in a single-visit assessment clinic. Eur J Vasc Endovasc Surg. May 2003;25(5):462-468.

7

Gohel MS, Heatley F, Liu X, et al. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. N Engl J Med. May 31, 2018;378(22)2105-2114.

8

Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: An EQ-5D-5L value set for England. Health Econ. January 2018;27(1):7-22.

9

Valencia I.C., Falabella A, Kirsner RS, et al. Chronic Venous Insufficiency and Venous Leg Ulceration. J Am Acad Dermatol. 2001; 44:401-21.

10

Phillips, T., Stanton, B., Provan, A., et al. A Study of the Impact of Leg Ulcers on Quality of Life: Financial, Social and Psychologic Implications. J Am Acad Dermatol. 1994; 31:49-53.

11

Green, J., Jester, R. Health-related Quality of Life and Chronic Venous Leg Ulceration: Part 1. Wound Care. 2009; December: S12-S17.

12

Kanth, A., Khan, S., Gasparis, A., Labropoulos, N., et al. The Distribution and Extent of Reflux and Obstruction in Patients with Active Venous Ulceration. Phlebology. 2015; 30(5): 350-6.

13

Sufian, S., Lakhanpal, S., Marquez, J., et al. Superficial Vein Ablation for the Treatment of Primary Chronic Venous Ulcers. Phlebology. 2011; 26:301-6.


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