 Introduction/Background Lower extremity venous insufficiency is a common chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis (DVT) or extrinsic venous obstruction. Venous insufficiency may cause varicosities that vary in presentation from cosmetic concern to chronic lower extremity discomfort, swelling, induration, dermatitis, and ulceration [1]. Varicose veins are dilated and usually tortuous subcutaneous veins measuring at least 3 mm in diameter in an upright position, larger than reticular veins (subdermal veins, 1-3 mm in diameter) and telangiectasia (intradermal veins, <1 mm in diameter) [1]. Venous disease of the legs can be categorized according to the severity, cause, site, and specific abnormality using the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification system [1,2]. The elements of the CEAP classification include, 1) Clinical severity (grade 0-6, asymptomatic, symptomatic), 2) Etiology (congenital, primary, secondary), 3) Anatomical distribution (superficial, deep, perforator veins), and 4) Pathophysiological dysfunction (reflux, obstruction). Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million men and 22 million women 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease [3]. Approximate total prevalence of C2 to C3 disease is 25% and 5% for stages C4 to C6 [1,3]. Additionally, most chronic leg ulcers are venous in origin, with prevalence of nearly 1% [4,5]. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly [4]. Treatment of superficial venous insufficiency is intended to alleviate symptoms and reduce the risk of complications.
Lower Extremity Chronic Venous Disease.  Introduction/Background Lower extremity venous insufficiency is a common chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis (DVT) or extrinsic venous obstruction. Venous insufficiency may cause varicosities that vary in presentation from cosmetic concern to chronic lower extremity discomfort, swelling, induration, dermatitis, and ulceration [1]. Varicose veins are dilated and usually tortuous subcutaneous veins measuring at least 3 mm in diameter in an upright position, larger than reticular veins (subdermal veins, 1-3 mm in diameter) and telangiectasia (intradermal veins, <1 mm in diameter) [1]. Venous disease of the legs can be categorized according to the severity, cause, site, and specific abnormality using the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification system [1,2]. The elements of the CEAP classification include, 1) Clinical severity (grade 0-6, asymptomatic, symptomatic), 2) Etiology (congenital, primary, secondary), 3) Anatomical distribution (superficial, deep, perforator veins), and 4) Pathophysiological dysfunction (reflux, obstruction). Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million men and 22 million women 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease [3]. Approximate total prevalence of C2 to C3 disease is 25% and 5% for stages C4 to C6 [1,3]. Additionally, most chronic leg ulcers are venous in origin, with prevalence of nearly 1% [4,5]. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly [4]. Treatment of superficial venous insufficiency is intended to alleviate symptoms and reduce the risk of complications.