The epidemiology, pathophysiology, and natural history of chronic venous disease.

Chronic venous disease includes a spectrum of clinical presentations ranging from varicose veins through chronic lower extremity pain and edema to venous skin changes and ulceration. Such manifestations may result from primary venous insufficiency or be secondary to other disorders, primarily acute deep venous thrombosis. Regardless of etiology, chronic venous disease has significant socioeconomic consequences and is among the most common problems encountered in surgical practice. Ambulatory venous hypertension underlies most of the sequelae of chronic venous disease, although such hemodynamic derangements may result from either valvular incompetence or venous obstruction. Unfortunately, the factors responsible for the progression of disease from mild to severe manifestations are only beginning to be understood. However, a thorough understanding of the pathophysiology and natural history of chronic venous disease is essential in its management.