Feature Article

Chronic venous insufficiency: the role of venous obstruction and treatment options




Abnormal venous reflux caused by venous incompetence has been the dominant concept in chronic venous insufficiency; however, the pivotal role of iliac venous obstructive lesions is now well recognised. Greater consideration should be given to investigating obstructive lesions when treating patients with venous ulcers, recurrent venous thrombosis and unresolved venous disease such as pelvic congestion syndrome. 

Key Points

  • Venous disease contributes considerably to the burden of disease for patients and healthcare services but is under-researched and undertreated.
  • Venous obstruction has been a largely neglected cause of chronic venous disease and remains underdiagnosed.
  • Patients presenting with severe symptoms of chronic venous insufficiency or a history of thrombosis should be evaluated with a thorough history, physical examination and detailed lower-extremity venous duplex scans, and referred to a vascular specialist to rule out iliac venous obstructive lesions.
  • Percutaneous balloon angioplasty and stenting appear to be a safe and effective treatment for venous obstruction, with significant clinical resolution of symptoms, prevention of recurrence of thrombosis and ulceration and acceptable long-term patency. 

    Picture credit: © Sebastian Kaulitzki/Shutterstock