From the Guidelines
The most effective treatment for chronic venous insufficiency (CVI) is compression therapy, with a minimum pressure of 20 to 30 mm Hg recommended, and pressures of 30 to 40 mm Hg advised for more severe disease 1.
Overview of Treatment
The treatment for CVI involves both conservative measures and medical interventions based on disease severity. Conservative management includes:
- Regular exercise
- Weight loss if overweight
- Leg elevation above heart level when resting
- Avoiding prolonged standing or sitting Compression therapy is the cornerstone of treatment, with graduated compression stockings worn daily from morning to evening.
Medical Interventions
Medications may include venoactive drugs such as:
- Micronized purified flavonoid fraction (MPFF, 1000 mg daily)
- Horse chestnut seed extract (300 mg twice daily)
- Pentoxifylline (400 mg three times daily) to improve symptoms For skin complications, topical treatments like zinc oxide or calamine lotion can help with itching, while moisturizers prevent skin dryness.
Advanced Cases
Advanced cases may require procedures such as:
- Endovenous thermal ablation
- Sclerotherapy
- Surgical vein stripping These interventions are necessary because CVI results from damaged vein valves causing blood pooling in the legs, leading to increased venous pressure and symptoms like swelling, pain, and skin changes, as noted in a study on interventional radiology 1.
Importance of Follow-up
Regular follow-up with healthcare providers is essential to monitor disease progression and adjust treatment as needed, with consideration of the latest guidelines on lower extremity chronic venous disease 1.
From the Research
Treatment Options for Chronic Venous Insufficiency (CVI)
The treatment for CVI can be divided into several categories, including:
- Conservative management
- Minimally invasive procedures
- Surgical interventions
Conservative Management
Conservative management of CVI includes:
- Compression therapy, which is the most successful conservative technique 2
- Compression devices such as elastic stockings, elastic bandages, inelastic bandages, and intermittent pneumatic compression devices 2
- Lifestyle modifications, such as reducing standing time and avoiding night shift rotation 3
Minimally Invasive Procedures
Minimally invasive procedures for CVI include:
- Ultrasound-guided foam sclerotherapy, which is a venous injection of sclerosing foam controlled by Doppler ultrasound 4
- Endovenous thermal ablation using laser or radiofrequency 4, 5
- Endovenous foam sclerotherapy 5
Surgical Interventions
Surgical interventions for CVI include:
- Superficial vein surgery and subfascial endoscopic perforator surgery (SEPS) 6
- High ligation with stripping, radiofrequency ablation, endovenous laser therapy, and foam sclerotherapy for ablation of saphenous vein reflux 6
- Surgical treatment of chronic venous insufficiency with high ligation in the groin and inversion stripping of the great saphenous vein to the knee combined with stab avulsion of varicose veins 6
Symptom Relief
Symptom relief for CVI can be achieved through: