How should I approach the management of a patient with chronic venous insufficiency in primary care?

Management of chronic venous insufficiency (CVI) in primary care should begin with a thorough clinical assessment including history and examination to identify symptoms such as leg pain, swelling, heaviness, skin changes, or ulcers. Provide patients with clear information about the condition, including causes, progression, possible complications (e.g., deep vein thrombosis, skin changes, leg ulcers), and treatment options to support informed decision-making.

For patients presenting with varicose veins or signs of CVI, consider referral to a vascular service if they have symptomatic primary or recurrent varicose veins, skin changes related to venous disease, superficial vein thrombosis, or venous leg ulcers (healed or active). Immediate referral is required for bleeding varicose veins.

In primary care, advise on conservative measures such as weight management, light to moderate physical activity, and avoiding factors that exacerbate symptoms. Compression hosiery is not routinely recommended to treat varicose veins unless interventional treatment is unsuitable or for symptom relief during pregnancy.

Use duplex ultrasound in secondary care to confirm diagnosis and plan treatment. Interventional treatments such as endothermal ablation, ultrasound-guided foam sclerotherapy, or surgery are offered in vascular services for confirmed truncal reflux. Compression bandaging or hosiery post-intervention should not exceed 7 days.