From the Guidelines
Venous insufficiency treatment should prioritize compression therapy with a minimum pressure of 20 to 30 mm Hg, and lifestyle changes such as elevating the legs and regular exercise, as these interventions have been shown to improve symptoms and quality of life 1.
Treatment Options
- Compression therapy:
- Minimum pressure of 20 to 30 mm Hg
- Pressures of 30 to 40 mm Hg for more severe disease
- Inelastic compression is better than elastic bandaging for wound healing 1
- Lifestyle modifications:
- Elevate the legs above heart level several times daily
- Regular exercise like walking to improve circulation
- Weight loss for overweight patients to reduce pressure on veins
- Avoid prolonged standing or sitting, and take regular breaks to move around
Medications and Procedures
- Symptom management: horse chestnut seed extract (typically 300mg twice daily containing 50mg aescin) and micronized purified flavonoid fraction (Daflon, 1000mg daily) may help reduce swelling and discomfort
- Procedures like sclerotherapy, endovenous laser treatment, radiofrequency ablation, or vein stripping might be necessary if conservative measures fail
Considerations
- Patient preferences and symptoms should guide treatment decisions
- Cost, potential for complications, availability of resources, insurance reimbursement, and physician training should also be considered
- The presence or absence of deep venous insufficiency and the characteristics of the affected veins can help guide treatment 1
From the Research
Treatment Options for Venous Insufficiency
- Compression therapy is a common treatment for venous insufficiency, which can be achieved through various methods, including static compression, specialized compression pumps, and manual lymphatic drainage 2
- Medical compression stockings are a standard, non-invasive treatment option for venous and lymphatic diseases, with evidence supporting their use in preventing and treating venous oedema and ulcers 3
- Graduated compression stockings are considered the basic treatment for chronic venous insufficiency, regardless of the patient's clinical classification, but adherence to treatment can be impaired by factors such as financial constraints and discomfort 4
Effectiveness of Compression Stockings
- Studies have shown that compression stockings can improve symptoms and reduce oedema in patients with varicose veins, but the evidence is generally of low to very low certainty due to the small size and variability of the studies 5
- There is insufficient high-certainty evidence to determine whether compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration 5
- Compression therapy, including wraps and garments, remains the mainstay of conservative therapy for patients with chronic venous insufficiency, with renewed interest in lifestyle and nutritional supplements, such as micronized purified flavanoid fraction (MPFF), in relieving symptoms and preventing morbidity 6
Adherence to Treatment
- Adherence to wearing graduated compression stockings can be a challenge, with reasons for non-adherence including financial constraints, pain, ignorance of the need to wear them, heat, and other factors 4
- The adherence rate to wearing compression stockings can be as low as 55.8%, highlighting the need for education and support to improve patient outcomes 4