Chronic venous insufficiency symptoms and its potential causes: Are we doing it right?

Background: Chronic venous insufficiency has symptomatology associated with venous hypertension; until now they have never been approached for the purpose of describing a characteristic pattern presentation allowing a clinical differential diagnosis. The largest study addressing this topic is the Vein Restoration Study (VRS) that included 38,750 patients demonstrating discrepancy between signs and symptoms among age groups studied, coupled with the fact that in our own medical practice as a vascular specialist we may face patients with advanced degrees of venous hypertension but completely asymptomatic. Symptoms have been reported as subjective and potentially confoundable with other comorbidities such as neuropathies, as there is a close anatomic relationship between veins and nerves. Methods: Electronic literature searches were performed from 1947 to 2021 by the first author using PubMed and the Cochrane Central Register of Controlled Trials. Results: We found 1200 articles using those related to venous symptoms noting any of them focused on the pattern presentation with evident discrepancies between signs and symptoms. Conclusion: Venous symptoms must be considered subjective, and potentially caused by an underlying and undefined condition or comorbity. Until now, no author has demonstrated that these are caused directly by venous disease