Clinical Crossroads Section Editor: Edward H. Livingston, MD, Deputy Editor, JAMA.
Author Affiliations: Dr Hamdan is Clinical Director of Vascular and Endovascular Surgery and Vice-Chairman of the Department of Surgery, Beth Israel Deaconess Medical Center, and Associate Professor of Surgery, Harvard Medical School, Boston, Massachusetts.
Chronic venous disease, reviewed herein, is manifested by a spectrum of signs and symptoms, including cosmetic spider veins, asymptomatic varicosities, large painful varicose veins, edema, hyperpigmentation and lipodermatosclerosis of skin, and ulceration. However, there is no definitive stepwise progression from spider veins to ulcers and, in fact, severe skin complications of varicose veins, even when extensive, are not guaranteed. Treatment options range from conservative (eg, medications, compression stockings, lifestyle changes) to minimally invasive (eg, sclerotherapy or endoluminal ablation), invasive (surgical techniques), and hybrid (combination of ≥1 therapies). Ms L, a 68-year-old woman with varicose veins, is presented. She has had vein problems over the course of her life. Her varicose veins recurred after initial treatment, and she is now seeking guidance regarding her current treatment options.
Hamdan A. Management of Varicose Veins and Venous Insufficiency. JAMA. 2012;308(24):2612–2621. doi:10.1001/jama.2012.111352
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