Management of Chronic Venous Disorders

Chronic venous disorders encompass a spectrum of conditions arising from impaired venous return in the lower limbs, ranging from telangiectasias and varicose veins to skin changes and venous ulceration. Management begins with conservative measures such as graduated compression therapy, limb elevation and structured exercise programmes to enhance calf muscle pump function. Pharmacological approaches deploy venoactive agents to stabilise the endothelium, reduce inflammation and improve microcirculation. Advances in endovenous interventions, including thermal ablation, mechanochemical ablation and cyanoacrylate closure, have largely supplanted traditional surgery for truncal vein incompetence, offering high closure rates, faster recovery and improved patient comfort. Sclerotherapy remains an effective option for smaller tributaries. A stratified care model, informed by duplex ultrasonography and clinical severity scoring, guides treatment selection. Multidisciplinary guidelines emphasise personalised plans that balance efficacy, safety, cost-effectiveness and patient preference, while recognising the importance of long-term follow-up to detect and manage recurrences or complications.

Research from Nature Portfolio

A genome-wide association study has identified novel susceptibility loci implicating extracellular matrix remodelling and angiogenic regulation in venous disease. Variants near EFEMP1, encoding a fibulin family glycoprotein, and KCNH8, a potassium channel gene, correlate with disease risk, highlighting the role of vessel wall integrity and ion-channel-mediated signalling in pathogenesis. These findings pave the way for molecular stratification of patients and the development of targeted therapies that address underlying genetic predispositions rather than solely focusing on mechanical correction.

Management of Chronic Venous Disorders publication trend

The graph below shows the total number of articles in management of chronic venous disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Ambulatory venous hypertension: Elevated venous pressure during walking due to valve failure and reflux.

Endovenous ablation: Minimally invasive destruction of incompetent veins using thermal, chemical or mechanical energy.

Venoactive agents: Pharmacological compounds that improve venous tone, reduce oedema and moderate inflammation.

Genome-wide association study (GWAS): A method to identify common genetic variants associated with disease across the entire genome.

Calf muscle pump: The mechanism by which calf muscle contraction propels venous blood toward the heart, critical for venous return.

References

1. Editor's Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. European Journal of Vascular and Endovascular Surgery (2022).
2. Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy. International Journal of Molecular Sciences (2018).
3. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management. Journal of Clinical Medicine (2021).
4. Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of incompetent great saphenous veins: 36-Month outcomes of the VeClose randomized controlled trial. Phlebology The Journal of Venous Disease (2018).
5. Two-year results of a multicenter randomized controlled trial comparing Mechanochemical endovenous Ablation to RADiOfrequeNcy Ablation in the treatment of primary great saphenous vein incompetence (MARADONA trial). Journal of Vascular Surgery Venous and Lymphatic Disorders (2019).
6. Genome-wide association analysis for chronic venous disease identifies EFEMP1 and KCNH8 as susceptibility loci. Scientific Reports (2017).