Synopsis
Recognise advanced chronic venous disease, define reflux and obstruction, and use safe compression, skin care and referral to prevent ulceration.
- CVI is advanced chronic venous disease with oedema, skin change or ulceration caused by sustained venous hypertension from reflux, obstruction, calf-pump failure or combinations.
- Examine the entire limb and abdomen and obtain full venous duplex for reflux or obstruction; identify acute DVT, arterial disease, infection, systemic oedema and proximal outflow clues before attributing symptoms to superficial veins.
- Before sustained compression measure ankle pressure and ABPI, adding toe pressure when calcification may make ABPI unreliable; avoid sustained compression below ABPI 0.6 or ankle pressure 60 mmHg, and in active mixed ulceration also below toe pressure 30 mmHg. Modified compression requires close supervision.
Key red flags
Abrupt asymmetric swelling, deep pain or new chest symptoms is not routine chronic venous disease and requires urgent VTE assessment.
Rest pain, gangrene, a cold foot, rapidly worsening tissue loss or absent pulses suggests severe arterial insufficiency; stop plans for sustained compression and obtain urgent vascular review.
Rapidly spreading erythema, fever, hypotension, crepitus or pain out of proportion suggests serious infection and needs urgent reassessment.
Acute breathlessness, orthopnoea, pulmonary oedema or unstable decompensated heart failure makes routine compression unsafe until haemodynamic status is assessed.
Prominent abdominal or cross-pubic collaterals, venous claudication or whole-limb swelling suggests proximal outflow obstruction and needs specialist imaging strategy.
Investigation priorities
Map superficial and deep reflux, identify post-thrombotic change or obstruction, and determine whether an anatomical target matches the clinical territory.
Management branches
Use for persistent lower-leg swelling, pigmentation, eczema, induration or suspected venous ulceration.
- Take a venous and VTE history, define daily symptom pattern and mobility, and examine standing varicosities, oedema distribution, skin, ulcers, pulses and abdominal collaterals.
- Exclude acute DVT, infection, severe arterial ischaemia and decompensated systemic disease before assigning a chronic venous diagnosis or applying compression.