From the Guidelines
For patients with suspected Chronic Venous Insufficiency (CVI) despite a negative Doppler study, compression therapy with a minimum pressure of 20 to 30 mm Hg is recommended as the initial treatment. This approach is based on the most recent evidence from the Journal of the American College of Radiology, which suggests that compression therapy can reduce venous stasis, improve venous blood flow velocity, and enhance lymphatic drainage 1.
When implementing compression therapy, it is essential to consider the type of compression device and the pressure gradient. The study by Rochon et al. suggests that negative graduated compression bandages, which exert higher pressures at the calf over the distal ankle, are more effective than graduated compression bandages in achieving improved ejection fraction in refluxing vessels and higher extrinsic pressures 1.
Key components of the treatment plan include:
- Compression therapy with a minimum pressure of 20 to 30 mm Hg, or 30 to 40 mm Hg for more severe disease
- Proper fitting, education, and detailed instructions to encourage adherence
- Consideration of alternative diagnostic approaches, such as venous plethysmography or magnetic resonance venography, if symptoms persist
- Additional conservative management strategies, including elevation of legs above heart level, regular exercise, and weight loss for overweight patients
It is crucial to note that while compression therapy has been shown to be effective in preventing ulcer recurrence and healing ulcers, the current evidence is limited, and further research is needed to fully understand its benefits and potential drawbacks 1. Nonetheless, compression therapy remains a valuable treatment option for patients with CVI, even in the presence of a negative Doppler study.
From the Research
Treatment Options for Chronic Venous Insufficiency (CVI)
- The standard of care in the therapy of CVI is the use of graduated elastic stockings (GECS) 2.
- Progressive compression stockings have been shown to be as effective as traditional graduated compression therapy for the management of CVI 3, 4.
- A study comparing progressive compressive stockings with degressive compressive stockings found that the progressive compressive stocking group had a significantly higher rate of success in improving symptoms of CVI 4.
Compression Stocking Types
- Graduated elastic stockings (GECS) have been shown to increase healing rates and reduce recurrence of venous leg ulceration (VLU) 2, 3.
- Inverse graduated compression stockings (PECS) have been found to be easier to don and put on compared to GECS, but may slip towards the foot more often 2.
- A compression stocking specifically designed for patients with both CVI and peripheral artery disease (PAD) has been shown to be safe and effective in improving CVI symptoms 5.
Alternative Treatment Options
- Ultrasound-guided foam sclerotherapy is a minimally invasive alternative treatment for varicose veins and has been found to be useful in treating varicose veins, although it is less studied than other methods 6.
- Venous thermal ablation using laser or radiofrequency is another alternative treatment option for varicose veins, but the choice of treatment depends on clinical and anatomical factors 6.