From the Guidelines
Treatment for chronic venous insufficiency should prioritize conservative management, including compression therapy with graduated compression stockings (20-30 mmHg or 30-40 mmHg for more severe cases), regular exercise, leg elevation, and weight loss for overweight patients, as these methods have been shown to improve symptoms and quality of life 1.
Conservative Management
Conservative management is the first line of treatment for chronic venous insufficiency and includes:
- Compression therapy using graduated compression stockings (20-30 mmHg or 30-40 mmHg for more severe cases) worn daily from morning to evening 1
- Regular exercise to improve venous return
- Leg elevation to reduce swelling
- Weight loss for overweight patients to reduce pressure on the veins
Medications
Medications such as venoactive drugs, including micronized purified flavonoid fraction (Daflon 500 mg twice daily), horse chestnut seed extract (300 mg twice daily), or pentoxifylline (400 mg three times daily), may be used to improve venous tone and reduce symptoms 1.
Invasive Options
For persistent symptoms, more invasive options may be considered, including:
- Sclerotherapy, where a solution is injected to close problematic veins
- Endovenous thermal ablation using laser or radiofrequency to seal larger varicose veins
- Surgical procedures like vein stripping or phlebectomy for severe cases These treatments work by either improving venous return through external compression, enhancing venous tone pharmacologically, or eliminating dysfunctional veins to redirect blood flow through healthier pathways 1.
Treatment Effectiveness
Regular follow-up is important to monitor treatment effectiveness and disease progression, with adjustments made as needed to ensure optimal outcomes 1.
From the Research
Treatment Options for Chronic Venous Insufficiency
The treatment options for chronic venous insufficiency (CVI) are aimed at reducing venous hypertension and promoting wound healing. The following are some of the treatment options:
- Compression therapy: This is the cornerstone in the management of CVI, and can be achieved using compression bandaging, compression pumps, or graduated compression stockings 2, 3, 4.
- Endovascular and surgical techniques: These techniques aim to minimize valvular reflux and relieve venous obstruction, improving venous hemodynamics and promoting wound healing 2, 5, 4.
- Pharmacologic agents: Diuretics and topical steroid creams can reduce swelling and pain in the short term, but offer no long-term treatment advantage 2, 4.
- Herbal supplements: Some herbal supplements, such as horse chestnut seed extract, may reduce the inflammatory response to venous hypertension, but their efficacy, quality, and safety vary 4.
- Apligraf: This is a living, bilayered, cell-based product that can be used in conjunction with compression therapy to promote wound healing 2.
Compression Therapy
Compression therapy is a key component of CVI treatment, and can be achieved using various methods, including:
- Compression bandaging
- Compression pumps
- Graduated compression stockings The pressure needed to achieve clinical benefit is a matter of debate, but studies suggest that compression with 10-20mmHg is effective in reducing oedema and symptoms 3. Compliance with compression therapy is a major issue, with only 21% of patients reporting daily use of compression stockings, and 63% not using them at all or abandoning them after a trial period 6.
Surgical Management
Surgical management of CVI involves procedures aimed at restoring normal venous physiology, such as:
- Ligation and stripping of incompetent perforator and superficial veins
- Removal of incompetent perforators or superficial veins to lessen local stasis
- Skin grafting of ulcers These procedures can be effective in managing superficial CVI, but deep CVI presents a more challenging condition that requires adjunctive surgical measures and management with elastic compression, elevation of the legs, and exercise 5.