About Chronic Venous Disease

Chronic venous disease is any morphological and functional abnormality of the venous system of long duration, manifested either by symptoms and/or signs indicating the need for investigation and/or care. Chronic venous disease is characterized by a wide range of symptoms (leg pain, aching, heaviness, a sensation of swelling, cramps, itching, tingling, and restless legs) and signs (reflux, telangiectasis, varicose veins, edema, skin changes, and leg ulcers), as described in the clinical CEAP classification. It is widely reported that leg symptoms can appear very early in the disease process, before the appearance of reflux or varicose veins.

Although the causal and temporal sequences of events that occur during the development and progression of chronic venous disease have not been ascertained, the emerging twin themes of disturbed venous-flow patterns and chronic inflammation may underlie all the clinical manifestations of the disease (Fig. 5). Early treatment aimed at preventing venous hypertension, reflux, and inflammation could alleviate symptoms of chronic venous disease and reduce the risk of ulcers, both of which reduce the quality of life and are expensive to treat.

Journey into the vein


  • Heavy legs
  • Leg pain
  • A sensation of swelling
  • Pins and needles in the legs
  • Pain along the course of a vein
  • A burning sensation
  • Cramps at night
  • Itching.


  • Telangiectasis or reticular veins (dilation of the capillaries which causes them to appear as small red or purple clusters on the skin, often spidery in appearance)
  • Varicose veins
  • Edema (swelling, for example in the ankles, caused by excess fluid in the body tissues)
  • Skin change (pigmentation, eczema, lipodermatosclerosis, atrophie blanche)
  • Healed venous leg ulcers
  • Active venous leg ulcers

Describing the severity of chronic venous disease

CVD is graded according to the CEAP classification (Clinical severity, Etiology, Anatomy, and Pathophysiology), which provides an orderly framework for diagnosis. The clinical signs in the affected legs are categorized into seven classes ranging from C0S to C6. Limbs categorized in any clinical class may be symptomatic or asymptomatic.

CEAP classification

Class Definition

C0S: Venous symptoms but no visible or palpable signs of chronic venous disease
C1: Telangiectases or reticular veins
C2: Varicose veins (distinguished from reticular veins by a diameter of (3 mm)
C3: Edema
C4: Skin changes secondary to chronic venous disease
C4a: Pigmentation or eczema
C4b: Lipodermatosclerosis or atrophie blanche
C5: Healed venous ulcer
C6: Active venous ulcer


is supported by an unrestricted grant from Servier research group
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