Development of diagnosis and treatment of chronic venous diseases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHI Zhenyu ¹ ,  WU Danming ²

1. Division of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
2. Division of Vascular Surgery, Liaoning Province People’s Hospital, Shenyang 110016, P. R. China;

Corresponding author：

WU Danming, Email: danming_w@126.com

Keywords：

chronic venous disease; imaging diagnosis; drug therapy; surgical treatment

DOI：

10.7507/1007-9424.202412066

Video：

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Abstract Full text Figures/Tables Video References Cited by

Chronic venous diseases are the most common vascular diseases, which are the key field of vascular surgery. This review focused on the development about imaging diagnosis (including ultrasound, CT venogram, magnetic resonance venogram, venography, and intravascular ultrasound), genetic screening, drug therapy (including venous active drugs, antithrombotic drugs, and sulodexide), compression therapy, and surgical treatment (including heat venous ablation, non-heat venous ablation, endovascular treatment of iliac vein, and repair of venous valves) of chronic venous diseases during the past years. This reflects the trend of preciseness, individualization, and microinvasiveness in this field.

Citation： SHI Zhenyu, WU Danming. Development of diagnosis and treatment of chronic venous diseases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(4): 416-421. doi: 10.7507/1007-9424.202412066 Copy

1.	何静, 王军, 杨涛. 慢性下肢静脉疾病的流行病学研究现状. 中国血管外科杂志(电子版), 2018, 10(1): 71-78.
2.	Salim S, Machin M, Patterson BO, et al. Global epidemiology of chronic venous disease: a systematic review with pooled prevalence analysis. Ann Surg, 2021, 274(6): 971-976.
3.	Needleman L, Feld R. Peripheral venous ultrasound. Radiol Clin North Am, 2025, 63(1): 165-178.
4.	Yang CH, Lu XW, Jiang WB, et al. Application of 3D digital reconstruction and printing to the diagnosis and treatment of Iliac vein compression. J Shanghai Jiao Tong Univ(Sci. ), 2021, 26(3): 312-318.
5.	Chen ZH, Huang Y, Wang LP, et al. Preliminary study of hemodynamics of iliac venous compression syndrome using magnetic resonance imaging. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 131-138.
6.	Nie C, Tao L, Chen J, et al. Application of 4D flow MRI for exploring factors affecting haemodynamics of iliac veins in asymptomatic population. Clin Hemorheol Microcirc, 2024, 87(4): 481-490.
7.	程永佳, 盛玉国, 武建, 等. 介入治疗髂静脉狭窄术中应用三维静脉造影影像融合导航. 中国介入影像与治疗学, 2022, 19(1): 58-60.
8.	Gagne PJ, Tahara RW, Fastabend CP, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord, 2017, 5(5): 678-687.
9.	丁勇, 赵格非, 周旻, 等. 血管腔内超声与静脉造影在髂静脉压迫综合征术中诊断价值的比较. 中华普通外科杂志, 2019, 34(9): 753-756.
10.	Shi MJ, Yan Y, Liu F, et al. Identification of biological significance of different stages of varicose vein development based on mRNA sequencing. Sci Rep, 2024, 14(1): 22536. doi: 10.1038/s41598-024-73691-3.
11.	Cui Y, Hu M, Zhou H, et al. Identifying potential drug targets for varicose veins through integration of GWAS and eQTL summary data. Front Genet, 2024, 15: 1385293. doi: 10.3389/fgene.2024.1385293.
12.	Khorev N, Kuznetsova D. Pharmacological correction of total venous reflux in patients with varicose veins. Phlebolymphology, 2022, 29(1): 42-45.
13.	Mezalek ZT, Feodor T, Chernukha L, et al. VEIN STEP: a prospective, observational, international study to assess effectiveness of conservative treatments in chronic venous disease. Adv Ther, 2023, 40(11): 5016-5036.
14.	Mansilha A, Sousa J. Benefits of venoactive drug therapy in surgical or endovenous treatment for varicose veins: a systematic review. Int Angiol, 2019, 38(4): 291-298.
15.	Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
16.	Milinis K, Thapar A, Shalhoub J, et al. Antithrombotic therapy following venous stenting: international Delphi consensus. Eur J Vasc Endovasc Surg, 2018, 55(4): 537-544.
17.	Guo B, Chen C, Li Y, et al. Principles of Optimal Antithrombotic Therapy for Iliac VEnous Stenting (POATIVES): a national expert-based Delphi consensus study. J Vasc Surg Venous Lymphat Disord, 2024, 12(2): 101739. doi: 10.1016/j.jvsv.2023.101739.
18.	Zieliński A, Jasińska-Sumińska K, Bręborowicz A, et al. Changes of the serum properties and its effect on the endothelial cells restoration in patients with chronic venous disease treated with sulodexide. J Vasc Surg Venous Lymphat Disord, 2024, 12(5): 101941. doi: 10.1016/j.jvsv.2024.101941.
19.	Pompilio G, Monreal M, Pesavento R, et al. Meta-analyses of sulodexide and other drugs in prevention and treatment of post-thrombotic syndrome. Eur Rev Med Pharmacol Sci, 2022, 26(24): 9372-9381.
20.	De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor’s choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022, 63(2): 184-267.
21.	中国医师协会血管外科医师分会静脉学组. 常见静脉疾病诊治规范 (2022年版). 中华普通外科学文献 (电子版), 2022, 16(4): 255-272.
22.	Shahzad N, Elsherif M, Obaidat I, et al. A systematic review and meta-analysis of randomised controlled trials comparing thermal versus non-thermal endovenous ablation in superficial venous incompetence. Eur J Vasc Endovasc Surg, 2023, 66(5): 687-695.
23.	Morrison N, Kolluri R, Vasquez M, et al. Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of incompetent great saphenous veins: 36-month outcomes of the VeClose randomized controlled trial. Phlebology, 2019, 34(6): 380-390.
24.	Kim H, Cho S, Lee K, et al. Clinical outcomes of nonthermal ablation, thermal ablation, and surgical stripping for varicose veins. J Vasc Surg Venous Lymphat Disord, 2024, 12(6): 101902. doi: 10.1016/j.jvsv.2024.101902.
25.	Anuforo A, Evbayekha E, Agwuegbo C, et al. Superficial venous disease-an updated review. Ann Vasc Surg, 2024, 105: 106-124.
26.	Kabnick LS, Jimenez JC, Coogan SM, et al. Comparative effectiveness of non-compounded polidocanol 1% endovenous microfoam (Varithena) ablation versus endovenous thermal ablation utilizing a systematic review and network meta-analysis. J Vasc Surg Venous Lymphat Disord, 2024, 12(6): 101896. doi: 10.1016/j.jvsv.2024.101896.
27.	Nugroho J, Wardhana A, Ghea C. Mechanical Occlusion Chemically Assisted Ablation (MOCA) for saphenous vein insufficiency: a meta-analysis of a randomized trial. Int J Vasc Med, 2020, 2020: 8758905. doi: 10.1155/2020/8758905.
28.	Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, et al. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev, 2021, 9(9): CD009648. doi: 10.1002/14651858.CD009648.pub4.
29.	Juhani AA, Abdullah A, Alyaseen EM, et al. Interventions for great saphenous vein insufficiency: a systematic review and network meta-analysis. Vascular, 2024: 17085381241273098. doi: 10.1177/17085381241273098.
30.	Dake MD, O’Sullivan G, Shammas NW, et al. Three-year results from the venovo venous stent study for the treatment of iliac and femoral vein obstruction. Cardiovasc Intervent Radiol, 2021, 44(12): 1918-1929.
31.	Comerota AJ, Gagne P, Brown JA, et al. Final 3-year study outcomes from the evaluation of the zilver vena venous stent for the treatment of symptomatic iliofemoral venous outflow obstruction (The VIVO Clinical Study). J Vasc Interv Radiol, 2024, 35(6): 834-845.
32.	Nguyen D, Pappas K, Mahadevan S, et al. The impact of stent protrusion into the inferior vena cava or jailing of the contralateral iliac vein on the incidence of contralateral deep vein thrombosis following venous stenting. Phlebology, 2025, 40(2): 80-87.
33.	Raju S, Kuykendall R. Experimental analysis of aspect ratio in iliac vein stenosis. J Vasc Surg Venous Lymphat Disord, 2021, 9(4): 1041-1050.
34.	Jayaraj A, Fuller R, Raju S. Role of laser ablation in recalcitrant instent restenosis post iliofemoral venous stenting. J Vasc Surg Cases Innov Tech, 2021, 7(2): 298-301.
35.	Götz A, Illner S, Fiedler N, et al. Transcatheter bicuspid venous valve prostheses: fluid mechanical performance testing of artificial nonwoven leaflets. Biomed Eng Online, 2024, 23(1): 124. doi: 10.1186/s12938-024-01316-x.

1. 何静, 王军, 杨涛. 慢性下肢静脉疾病的流行病学研究现状. 中国血管外科杂志(电子版), 2018, 10(1): 71-78.
2. Salim S, Machin M, Patterson BO, et al. Global epidemiology of chronic venous disease: a systematic review with pooled prevalence analysis. Ann Surg, 2021, 274(6): 971-976.
3. Needleman L, Feld R. Peripheral venous ultrasound. Radiol Clin North Am, 2025, 63(1): 165-178.
4. Yang CH, Lu XW, Jiang WB, et al. Application of 3D digital reconstruction and printing to the diagnosis and treatment of Iliac vein compression. J Shanghai Jiao Tong Univ(Sci. ), 2021, 26(3): 312-318.
5. Chen ZH, Huang Y, Wang LP, et al. Preliminary study of hemodynamics of iliac venous compression syndrome using magnetic resonance imaging. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 131-138.
6. Nie C, Tao L, Chen J, et al. Application of 4D flow MRI for exploring factors affecting haemodynamics of iliac veins in asymptomatic population. Clin Hemorheol Microcirc, 2024, 87(4): 481-490.
7. 程永佳, 盛玉国, 武建, 等. 介入治疗髂静脉狭窄术中应用三维静脉造影影像融合导航. 中国介入影像与治疗学, 2022, 19(1): 58-60.
8. Gagne PJ, Tahara RW, Fastabend CP, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord, 2017, 5(5): 678-687.
9. 丁勇, 赵格非, 周旻, 等. 血管腔内超声与静脉造影在髂静脉压迫综合征术中诊断价值的比较. 中华普通外科杂志, 2019, 34(9): 753-756.
10. Shi MJ, Yan Y, Liu F, et al. Identification of biological significance of different stages of varicose vein development based on mRNA sequencing. Sci Rep, 2024, 14(1): 22536. doi: 10.1038/s41598-024-73691-3.
11. Cui Y, Hu M, Zhou H, et al. Identifying potential drug targets for varicose veins through integration of GWAS and eQTL summary data. Front Genet, 2024, 15: 1385293. doi: 10.3389/fgene.2024.1385293.
12. Khorev N, Kuznetsova D. Pharmacological correction of total venous reflux in patients with varicose veins. Phlebolymphology, 2022, 29(1): 42-45.
13. Mezalek ZT, Feodor T, Chernukha L, et al. VEIN STEP: a prospective, observational, international study to assess effectiveness of conservative treatments in chronic venous disease. Adv Ther, 2023, 40(11): 5016-5036.
14. Mansilha A, Sousa J. Benefits of venoactive drug therapy in surgical or endovenous treatment for varicose veins: a systematic review. Int Angiol, 2019, 38(4): 291-298.
15. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
16. Milinis K, Thapar A, Shalhoub J, et al. Antithrombotic therapy following venous stenting: international Delphi consensus. Eur J Vasc Endovasc Surg, 2018, 55(4): 537-544.
17. Guo B, Chen C, Li Y, et al. Principles of Optimal Antithrombotic Therapy for Iliac VEnous Stenting (POATIVES): a national expert-based Delphi consensus study. J Vasc Surg Venous Lymphat Disord, 2024, 12(2): 101739. doi: 10.1016/j.jvsv.2023.101739.
18. Zieliński A, Jasińska-Sumińska K, Bręborowicz A, et al. Changes of the serum properties and its effect on the endothelial cells restoration in patients with chronic venous disease treated with sulodexide. J Vasc Surg Venous Lymphat Disord, 2024, 12(5): 101941. doi: 10.1016/j.jvsv.2024.101941.
19. Pompilio G, Monreal M, Pesavento R, et al. Meta-analyses of sulodexide and other drugs in prevention and treatment of post-thrombotic syndrome. Eur Rev Med Pharmacol Sci, 2022, 26(24): 9372-9381.
20. De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor’s choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022, 63(2): 184-267.
21. 中国医师协会血管外科医师分会静脉学组. 常见静脉疾病诊治规范 (2022年版). 中华普通外科学文献 (电子版), 2022, 16(4): 255-272.
22. Shahzad N, Elsherif M, Obaidat I, et al. A systematic review and meta-analysis of randomised controlled trials comparing thermal versus non-thermal endovenous ablation in superficial venous incompetence. Eur J Vasc Endovasc Surg, 2023, 66(5): 687-695.
23. Morrison N, Kolluri R, Vasquez M, et al. Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of incompetent great saphenous veins: 36-month outcomes of the VeClose randomized controlled trial. Phlebology, 2019, 34(6): 380-390.
24. Kim H, Cho S, Lee K, et al. Clinical outcomes of nonthermal ablation, thermal ablation, and surgical stripping for varicose veins. J Vasc Surg Venous Lymphat Disord, 2024, 12(6): 101902. doi: 10.1016/j.jvsv.2024.101902.
25. Anuforo A, Evbayekha E, Agwuegbo C, et al. Superficial venous disease-an updated review. Ann Vasc Surg, 2024, 105: 106-124.
26. Kabnick LS, Jimenez JC, Coogan SM, et al. Comparative effectiveness of non-compounded polidocanol 1% endovenous microfoam (Varithena) ablation versus endovenous thermal ablation utilizing a systematic review and network meta-analysis. J Vasc Surg Venous Lymphat Disord, 2024, 12(6): 101896. doi: 10.1016/j.jvsv.2024.101896.
27. Nugroho J, Wardhana A, Ghea C. Mechanical Occlusion Chemically Assisted Ablation (MOCA) for saphenous vein insufficiency: a meta-analysis of a randomized trial. Int J Vasc Med, 2020, 2020: 8758905. doi: 10.1155/2020/8758905.
28. Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, et al. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev, 2021, 9(9): CD009648. doi: 10.1002/14651858.CD009648.pub4.
29. Juhani AA, Abdullah A, Alyaseen EM, et al. Interventions for great saphenous vein insufficiency: a systematic review and network meta-analysis. Vascular, 2024: 17085381241273098. doi: 10.1177/17085381241273098.
30. Dake MD, O’Sullivan G, Shammas NW, et al. Three-year results from the venovo venous stent study for the treatment of iliac and femoral vein obstruction. Cardiovasc Intervent Radiol, 2021, 44(12): 1918-1929.
31. Comerota AJ, Gagne P, Brown JA, et al. Final 3-year study outcomes from the evaluation of the zilver vena venous stent for the treatment of symptomatic iliofemoral venous outflow obstruction (The VIVO Clinical Study). J Vasc Interv Radiol, 2024, 35(6): 834-845.
32. Nguyen D, Pappas K, Mahadevan S, et al. The impact of stent protrusion into the inferior vena cava or jailing of the contralateral iliac vein on the incidence of contralateral deep vein thrombosis following venous stenting. Phlebology, 2025, 40(2): 80-87.
33. Raju S, Kuykendall R. Experimental analysis of aspect ratio in iliac vein stenosis. J Vasc Surg Venous Lymphat Disord, 2021, 9(4): 1041-1050.
34. Jayaraj A, Fuller R, Raju S. Role of laser ablation in recalcitrant instent restenosis post iliofemoral venous stenting. J Vasc Surg Cases Innov Tech, 2021, 7(2): 298-301.
35. Götz A, Illner S, Fiedler N, et al. Transcatheter bicuspid venous valve prostheses: fluid mechanical performance testing of artificial nonwoven leaflets. Biomed Eng Online, 2024, 23(1): 124. doi: 10.1186/s12938-024-01316-x.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Development of diagnosis and treatment of chronic venous diseases

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