Chronic Venous Disease: Lower-extremity Varicose Veins, Disuse Edema, and Venous Leg Ulcers

Abstract

 Chronic venous disease encompasses a spectrum ranging from varicose veins and edema to skin and subcutaneous tissue changes and venous leg ulcers. Its pathophysiology involves not only venous hypertension caused by reflux or obstruction but also impaired calf-muscle pump function and reduced physical activity. In older adults and patients with gait impairment, prolonged sitting and dependent leg positioning may produce functional venous stasis and so-called disuse edema, even without significant venous reflux or obstruction. Clinical assessment should include history taking, inspection, palpation, and lower-extremity venous duplex ultrasonography, together with evaluation for systemic disease, lymphedema, and drug-induced edema. Assessing how patients use their legs in daily life is also essential. Management should be tailored to the underlying pathology and may combine treatment of correctable venous lesions, compression therapy, exercise aimed at maintaining or restoring physical activity, skin care, and wound management. Multidisciplinary care is essential to integrate vascular findings with functional status and to support sustained treatment.