The physical evidence of prolonged venous reflux is called chronic venous insufficiency (CVI). Below, you can see pictures related to the three stages of CVI along with the Duplex ultrasound vein mapping of valve failure with resulting venous hypertension and chronic venous insufficiency for the corresponding patient.
Overview
Spider veins, reticular veins and large veins are all manifestations of the same disease affecting different organs. Superficial veins are seen at the right side of the diagram with larger, deeper veins at the left. When valve function fails, there is nothing to stop blood from falling down the leg in the saphenous veins and their branches. As gravity pulls blood down to the lower parts of the leg through non-functioning valves, venous hypertension develops. The resultant pressure build-up in these branches causes them to enlarge. This is represented by the varicose tributary coming off of the saphenous vein in the diagram. Consequently, we see that all abnormal veins of any size--from spider veins all the way to the largest varicosities--are caused by the same underlying process: valve failure and venous insufficiency with resulting venous hypertension.
Small, Medium and Large Vein Disease
On the left side, we see small and medium vein disease or telangiectatic and reticular vein disease. The small abnormal veins are the red and purple veins that we see higher in the picture. The medium sized or reticular vein disease is seen as the more pale greenish veins. In the picture on the right, we see more typical large varicose veins. The large bulging vein seen in this picture is actually a varicose tributary branching off of a refluxing saphenous trunk.
Appearance of Vein Disease (CEAP) - Edema
Appearance of Vein Disease (CEAP) CVI - Edema of the foot and ankle is a common finding in patients with venous insufficiency. In this particular case, there is reflux from her saphenofemoral junction at the top of her leg all the way to the smaller branches going to her ankle and foot.
Corona Phlebectatica Paraplantaris
Corona phlebectatica consists of a myriad of tiny vein branches that are so fine and numerous that individual veins can be difficult to delineate. These veins give the skin a red-pink hue that blanches upon finger pressure. Once pressure is released, the pink color returns immediately. Although not technically a physical finding that is included in a CEAP clinical classification, it is felt by many experts that corona phlebectatica should be part of the C3 clinical class. It is almost always seen in association with larger underlying vein disease that might not be visible at the skin surface. Corona phlebectatica is often seen in combination with venous valve failure which results in venous hypertension and chronic venous disorder and has been shown to be statistically associated with a higher risk of venous ulcer development.
Appearance of Vein Disease (CEAP) - Hyperpigmentation
CEAP Clinical Class 4: Dermatologic changes that occur as a result of underlying vein disease. Hyperpigmentation is a very common finding.
Appearance of Vein Disease (CEAP) - Eczematoid Venous Dermatitis
Eczematoid venous dermatitis is seen less commonly. When it does occur, it can be symptomatic with tenderness and/or pruitis. Eczematoid venous dermatitis can commonly be confused with eczema. When the cause of the dermatitis is underlying vein disease that is not readily seen at the surface of the skin, accurate diagnosis relies upon duplex ultrasound evaluation of the venous system.
Appearance of Vein Disease (CEAP): Lipodermatosclerosis
Lipodermatosclerosis is a finding that is quite commonly seen but not frequently recognized. The appearance of lipodermatosclerosis is more dramatic when there is associated edema, as seen in this picture. Lipodermatosclerosis causes a scarring and fibrosis of the skin and underlying subcutaneous tissue. This results in significant discoloration and retraction of the affected skin.
Appearance of Vein Disease (CEAP) - Ulcers
Ulceration defines CEAP Clinical Class 6 or end stage chronic venous insufficiency. The goal of treatment must be to take care of underlying vein disease before end-stage venous insufficiency is reached so that ulceration can be avoided.
