How is venous stasis (venous insufficiency) managed?

From the Guidelines

Venous stasis is most effectively managed with compression therapy, which has been shown to reduce venous stasis by improving venous blood flow velocity, reducing blood pooling, and improving venous pumping function 1.

Key Components of Management

• Compression therapy involves the use of devices to provide extrinsic compression on the lower extremity, with a minimum pressure of 20 to 30 mm Hg recommended for mild cases and 30 to 40 mm Hg for more severe disease 1.
• The use of graduated compression stockings, with higher pressures exerted at the calf over the distal ankle, has been shown to achieve improved ejection fraction in refluxing vessels and higher extrinsic pressures 1.
• Lifestyle modifications, such as elevating the affected limbs, regular exercise, and weight management, are also important in reducing venous stasis 1.
• Medications, including venoactive drugs like micronized purified flavonoid fraction (Daflon) and horse chestnut seed extract, may be used to improve venous tone and reduce inflammation 1.

Considerations for Treatment

• The decision to proceed with treatment and the choice of treatment should be based on symptoms and patient preferences, as well as considerations such as cost, potential for complications, and availability of resources 1.
• In severe cases resistant to conservative management, procedures such as endovenous ablation, sclerotherapy, or surgical vein stripping may be considered 1.
• Proper wound care with moist wound healing principles is necessary for venous stasis ulcers, often using specialized dressings changed every 1-3 days depending on drainage 1.

From the Research

Management of Venous Stasis

Venous stasis can be managed through various methods, including:

• Lifestyle modifications, such as performing daily intervals of leg elevation to control edema, using elastic compression garments, and moderate physical activity, such as walking wearing below-knee elastic stockings 2
• Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management 2
• The use of pharmacological agents, such as pentoxifylline and phlebotropic agents, can also be effective in managing venous stasis 2
• Non-pharmacological interventions, such as graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCD), can also be used to prevent venous thromboembolism (VTE) in certain populations 3, 4

Non-Pharmacological Interventions

Non-pharmacological interventions, such as:

• Graduated compression stockings (GCS) can be used to prevent VTE, but their effectiveness is limited and they can cause side effects 4
• Intermittent pneumatic compression devices (IPCD) can be effective in reducing mortality from all causes and decreasing the incidence of deep vein thrombosis, but their use should be reserved for patients who can derive the maximum benefit from the intervention 4
• Medical compression stockings can be used to treat venous and lymphatic disorders, with moderately robust evidence for their use in patients with venous symptoms and prevention and treatment of venous oedema 5

Specific Populations

In specific populations, such as:

• Standing workers, the use of compression stockings can improve symptoms of leg fatigue, but the evidence is limited and further studies are needed 3
• Stroke patients, the use of IPCD can be effective in preventing VTE, but further confirmation is needed from future studies 4
• Patients with chronic venous disorders, medical compression stockings can be used to prevent and treat venous leg ulcers, with robust evidence supporting their use 5