1. References
   1. Agus, G. B., (2016). Conservative treatment of chronic venous disease: the Italian experience. Phleboloympholoy. Retrieved from the website http://www.phlebolymphology.org/conservative-treatment-of-chronic-venous-disease- the-italian/
   2. Cleveland Clinic, (2015). Chronic Venous Insufficiency. Retrieved from the website http://my.clevelandclinic. org /services/heart/disorders/arterial-and-vascular/disease/chronic-venous-insufficiency
   3. Huether, S.E. & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
   4. Vascular Disease Foundation, (2011). What is Chronic Venous Insufficiency (CVI)? Retrieved from the website http://vasculardisease.org/flyers/chronic-venous-insufficiency-flyer.pdf
   5. Zimbron, J. (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://MedMaps.co.uk
2. Epidemiology
   1. In the U.S.A. by the age of fifty 40% of females and 20% of males are effected by CVI
   2. Chronic Venous Disease the mother to CVI is found to be around 64% worldwide
3. Pathophysiology
   1. Sluggish circulation to the extremities that needed demands of oxygen and nutrients are not met
   2. Inability for venous return to remove wastes adequately
   3. Pressure and simple trauma causes cell death and due to chronic poor circulation cells without adequate oxygen are unable to repair damages
4. Treatment
   1. Noninvasive therapy
      1. Compression therapy
      2. Elevating Legs
      3. Physical Exercise
   2. Lifestyle Changes
      1. Elevate your legs above the level of your heart when sitting
      2. If overweight lose weight.
      3. Limit smoking and alcohol abuse
      4. Prompt a healthy diet and physical activity
      5. Avoid long periods of standing or sitting
   3. Noninvasive testing
      1. Venography
         1. Reflux
            1. Superficial ---->Venous Ablation or Stripping
            2. Deep ---->Vein Reconstruction
            3. Perforator ---->SEPS or Subfascial Endoscopic Perforator Surgery
         2. Non-Acute Obstruction ---->Venous Stenting
      2. Sclerotherapy ----> Injection into veins to create swelling and cause coagulation of blood thus narrowing of the blood vessel wall
      3. Vasoactive Drugs ---->lvenor, Ardium, Arvenum 500, Capiven, Daflon 500 mg, Detralex, Elatec, Flebotropin, Variton, Venitol
      4. Muscle Pump Dysfunction ----> Physical Exercise
      5. Endovenous Thermal Ablation
5. Diagnosis
   1. Complete medical history
   2. Physical Exam (examine legs closesly)
   3. A vascular or duplex ultrasound
      1. Images of the vessel
      2. Examine the blood circulation in legs
6. Clinical Presentation
   1. Edema in lower extremities
      1. Pain/ Aching
      2. Heaviness
   2. Hyper-pigmentation of feet and ankles
      1. Itching
      2. Skin irritation
      3. Ulcers