From the Guidelines
Treatment for chronic venous insufficiency (CVI) should begin with conservative measures, including wearing graduated compression stockings daily with a pressure of 20-30 mmHg for mild cases and up to 30-40 mmHg for more severe cases, as recommended by the most recent study 1. The goal of treatment is to alleviate symptoms, reduce the risk of complications, and improve quality of life. Conservative measures also include elevating the legs above heart level for 15-30 minutes, several times a day, and regular exercise, such as walking or swimming, to improve circulation. Maintaining a healthy weight and avoiding prolonged standing or sitting are also essential.
For symptom relief, patients can consider taking over-the-counter pain relievers like ibuprofen or applying topical anti-inflammatory creams. In more advanced cases, medications such as pentoxifylline (400 mg three times daily) may be prescribed to improve blood flow, or diuretics to reduce fluid retention.
For persistent symptoms, medical procedures may be necessary. These can include:
- Sclerotherapy for smaller veins, where a solution is injected to close off the affected vein
- Endovenous laser treatment for larger veins
- Surgical options like vein stripping for severe cases
These treatments work by improving blood flow in the legs, reducing swelling, and alleviating pressure on the veins. Compression therapy, in particular, helps by providing external pressure to assist the muscles in pushing blood back towards the heart, countering the effects of gravity and weakened vein valves characteristic of CVI, as supported by studies 1.
Key considerations in treatment selection include the severity of symptoms, patient preferences, and the presence or absence of deep venous insufficiency. The choice of treatment should be based on the individual patient's needs and circumstances, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the Research
Treatment Options for Chronic Venous Insufficiency (CVI)
The treatment options for CVI can be categorized into conservative and invasive approaches.
- Conservative treatment:
- Compression therapy is the most successful conservative technique, which can be achieved through various devices such as elastic stockings, elastic bandages, inelastic bandages, and intermittent pneumatic compression devices 2.
- Compression therapy has been shown to decrease edema, soften lipodermatosclerosis, accelerate venous flow, and improve microcirculation and lymph drainage 2.
- Graduated elastic stockings (GECS) and inverse graduated compression stockings (PECS) are two types of compression stockings used in the treatment of CVI, with GECS resulting in a significantly greater improvement of venous function than PECS 3.
- Invasive treatment:
- Invasive treatment modalities include open surgery, endovenous laser or radiofrequency ablation, and foam sclerotherapy 4.
- Key indications for invasive treatment include legs with skin damage or ulceration 4.
- The results of endovenous treatments are comparable with open surgery in mid-term follow-up studies 4.
Comparison of Compression Therapies
- Progressive compression versus graduated compression:
- The traditional view that compression therapy must provide a graduated pressure gradient has been challenged, with some studies suggesting that progressive compression may be as effective as traditional graduated compression therapy for the management of CVI 5.
- However, more research is needed to fully understand the benefits and drawbacks of each approach 5.
Additional Considerations
- The choice of compression material and method should be based on the patient's needs and clinical findings, and should be monitored for any loss of effectiveness during regular follow-up examinations 6.
- Duplex ultrasound investigation is the cornerstone of diagnosis and is also mandatory in the planning of invasive treatment 4.