Controversies surounding symptoms and signs of chronic venous disorders

Association of so-called venous symptoms (aching, itching, tingling, burning sensation, swelling, easily fatigued legs, leg heaviness, and leg restlessness) with chronic venous disease (CVD) still remains a controversial issue. Although these symptoms and a decreased quality of life are common in patients with venous incompetence, and are even more frequent in those with a history of venous thrombosis and/or recurrent and bilateral varicose veins, research has actually revealed that these complaints are poorly correlated with objective signs of venous insufficiency. A venous source for these complaints is obvious in patients with advanced CVD, but a substantial part of venous symptoms, especially in patients with telangiectasias and uncomplicated varicose veins, is actually not of venous origin. In addition, such symptoms can be reported by many patients presenting with nonvenous diseases, while uncomplicated varicose veins can cause few symptoms or be asymptomatic. In many venous patients, these symptoms are not permanent, but can only be seen at the end of the day. Therefore, it is important to consider and investigate an alternative cause of such "venous" complaints, especially because other pathologies can accompany CVD and produce similar symptoms. The most common pathologies that may be responsible and should be taken into account include spinal disc herniation, hip and knee arthrosis, peripheral arterial disease, joint and ligament overload due to obesity, peripheral neuropathy, and adverse drug reactions.