[Chronic venous insufficiency: clinical aspects].

Manifestations of chronic venous insufficiency of the lower limbs are related to congenital or acquired stasis in the deep veins, to post-phlebitis occlusion of the deep veins or to stasis in the superficial veins. Functional impairment may be associated with varicose veins or not. Clinical signs include a heavy feeling in the legs, fatigue, and sometimes cramps or impatience in the evening. Sometimes there is a seasonal character to the complaints. The varicosities are localized in the territory of the medial saphenous vein, the lateral saphenous vein, or both and sometimes affect the pelvic region. Complications may occur including hemorrhage of the varicose veins, superficial phlebitis or orthostatic hypotension. An echo coupled Doppler helps determine the therapeutic indications and provides a mapping of the venous system for functional evaluations. Varicose veins result from minute dilatations of superficial vessels. There are exclusively of aesthetic importance. Chronic venous insufficiency can lead to permanent or intermittant oedema of the lower limbs without inflammation. When permanent, a large cold leg fits into a suggestive clinical picture non venous causes of oedema can be determined with an ultrasound exploration. Postphlebitic reactions are the most frequent causes of large cold lower limbs due to venous insufficiency. Poor cutaneous trophism of venous origin includes dermo-epidermitis, pigmented purpura dermitis, capillary ectasia, leukoderma, sclerodermiform hypodermitis and leg ulcers. Superficial venous ulcers are often quite large, painless and chronic. Their prevalence increases with age. Venous ulcers are more often secondary to phlebitis than to varicose veins. The socio-economic impact is great.