Initial clinical evaluation in patients with chronic venous insufficiency

Venous leg ulcers (VLUs) represent the most advanced stage of chronic venous insufficiency (CVI) and occur in 0.3% of the adult population in Western countries. It is critical for healthcare professionals to perform a thorough clinical evaluation as the initial step in the management of patients with this very common pathology. The diagnosis of venous ulcers is mainly clinical but inconsistencies and overlap between symptoms and clinical signs may require additional diagnostic studies such as ultrasonography, plethysmography, or venography. Correctly examining a VLU and performing a detailed history will advance understanding of the ulcer pathogenesis and personalize the management plan.The purpose of this chapter is to provide step-by-step clinical guidelines to healthcare professionals on how to perform the proper initial evaluation of patients with a lower extremity ulcer including a thorough medical history with an assessment of risk factors for VLU and contributing conditions, physical examination, deep and superficial venous Duplex ultrasound, determination of additional appropriate imaging modalities, classification into the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) system, and assignment of a Venous Clinical Severity Score (VCSS).