From the Guidelines
Treatment for venous insufficiency should begin with conservative measures, including regular exercise, leg elevation, and compression therapy, with compression stockings (20-30 mmHg or 30-40 mmHg for more severe cases) worn daily to reduce swelling and improve blood flow, as recommended by the most recent study 1.
Conservative Measures
- Regular exercise to improve circulation
- Leg elevation to reduce swelling
- Compression therapy with stockings (20-30 mmHg or 30-40 mmHg for more severe cases) to improve blood flow
- Weight loss for overweight patients to reduce pressure on veins
Symptomatic Relief
- Venoactive drugs like micronized purified flavonoid fraction (Daflon 500 mg twice daily) or horse chestnut seed extract (300 mg twice daily) to reduce pain and swelling
- Pentoxifylline (400 mg three times daily) for advanced disease
Interventional Procedures
- Endovenous thermal ablation, sclerotherapy, or surgical vein stripping may be necessary for more severe cases, as supported by studies 1
- These treatments target the underlying cause by eliminating incompetent veins, allowing blood to reroute through healthier vessels
Specialized Wound Care
- For venous ulcers, specialized wound care with moist dressings and compression is essential
- Patients should avoid prolonged standing or sitting, elevate legs when possible, and maintain regular follow-up care to prevent progression of the disease and development of complications like ulcers or deep vein thrombosis, as emphasized by 1.
From the Research
Treatment of Venous Insufficiency
- The use of therapeutic compression stockings has been shown to be an effective treatment for chronic venous insufficiency (CVI) of the lower extremities, with a statistically significant improvement in patient severity scores for lower extremity swelling, pain, skin discoloration, activity tolerance, depression, and sleeping problems 2.
- Compression therapy, including the use of graduated compression stockings, is considered the basic treatment for CVI regardless of the patient's clinical classification 3.
- The adherence rate to wearing graduated compression stockings has been observed to be around 55.8%, with the most prevalent reason for not wearing stockings being financial 3.
- Medical compression stockings have been found to have a beneficial effect in the treatment of venous and lymphatic disease, with 19/25 recommendations rated as Grade 1 evidence 4.
- The use of compression stockings has been shown to reduce the incidence of post-thrombotic syndrome, but only when used as an immediate treatment after diagnosis of deep venous thrombosis, and the effect is dependent on the scoring instrument and cut-off time used 5.
Types of Compression Stockings
- Different types and pressures of compression stockings have been compared, but no conclusive results have been found to determine the optimum length or pressure of compression stockings 6.
- Knee-length stockings, full-length stockings, and full tights have been used in studies, with varying levels of pressure, ranging from 10 mmHg to 50 mmHg 6.
Adherence and Compliance
- Adherence to wearing compression stockings is crucial for effective treatment, but non-adherence rates have been reported to be around 44.2% 3.
- Reasons for non-adherence include financial constraints, pain, ignorance of the need to wear stockings, heat, and other factors 3.
- Compliance rates have been reported to vary between studies, with some studies showing good levels of compliance, while others report high dropout rates due to discomfort, application, and appearance 6.