From the Guidelines
The gold standard for treating venous insufficiency is compression therapy, particularly graduated compression stockings that provide 20-30 mmHg or 30-40 mmHg of pressure at the ankle, with decreasing pressure up the leg. This is based on the most recent and highest quality study available, which emphasizes the importance of compression therapy in managing venous insufficiency 1.
Key Points to Consider
- Compression therapy works by applying external pressure to the leg, which improves venous return, reduces venous pressure, prevents venous stasis, and decreases leg edema 1.
- The recommended pressure for compression therapy is a minimum of 20 to 30 mm Hg, with higher pressures of 30 to 40 mm Hg advised for more severe disease 1.
- In addition to compression therapy, lifestyle modifications are important adjuncts, including regular exercise (particularly walking), weight loss if overweight, elevating legs when sitting, and avoiding prolonged standing or sitting.
- For patients with more severe disease or those who don't respond to compression therapy, interventional procedures such as endovenous thermal ablation, sclerotherapy, or surgical options may be considered, but compression therapy remains the cornerstone of management for most patients with venous insufficiency 1.
Important Considerations for Compression Therapy
- Patients should wear compression stockings during the day and remove them at night.
- For optimal results, stockings should be put on in the morning before getting out of bed when leg swelling is minimal.
- Adherence to compression therapy should be encouraged with proper fitting, education, and detailed instructions 1.
From the Research
Treatment Options for Venous Insufficiency
The treatment of venous insufficiency can vary depending on the severity and individual patient needs. Some of the available treatment options include:
- Endovascular techniques, such as endovenous laser therapy 2
- Open-surgical options, such as phlebectomy 2
- Compression therapy, including compression stockings and wraps 3, 4, 5
- Sclerotherapy, including ultrasound-guided foam sclerotherapy (UGFS) 2
Gold Standard for Treating Venous Insufficiency
The gold standard for treating venous insufficiency is not a single treatment, but rather a tailored approach that takes into account the individual patient's disease severity, anatomy, quality of life, and expectations 6. Compression therapy is a widely accepted and evidence-based treatment option for venous insufficiency, with strong recommendations for its use in patients with venous symptoms and prevention and treatment of venous edema 4, 5. Endovenous laser therapy with echosclerotherapy has also shown promising results, with a high efficiency of 98% at the 12-month follow-up 2.
Key Considerations
When selecting a treatment option for venous insufficiency, it is essential to consider the following factors: