From the Guidelines
Furosemide (Lasix) is not beneficial for chronic venous insufficiency (CVI) as a primary treatment. The most recent and highest quality study, published in 2023 in the Journal of the American College of Radiology 1, emphasizes the importance of compression therapy in managing CVI, particularly for venous leg ulcers. Compression therapy, with a minimum pressure of 20 to 30 mm Hg, is recommended to reduce venous stasis, improve lymphatic drainage, and enhance venous pumping function.
Key aspects of compression therapy include:
- Using a wide range of devices to provide extrinsic compression on the lower extremity
- Applying pressures of 30 to 40 mm Hg for more severe disease
- Utilizing negative graduated compression bandages, which exert higher pressures at the calf over the distal ankle, to achieve improved ejection fraction in refluxing vessels and higher extrinsic pressures
The study highlights that improved pressures and ejection fractions are also observed when placing the compression bandage over the calf versus the distal leg 1. While loop diuretics like Lasix may temporarily reduce edema, they do not address the underlying venous valve dysfunction that causes CVI. Furthermore, long-term use of Lasix can lead to electrolyte imbalances and dehydration.
Instead, pharmacological options like venoactive drugs, which strengthen vein walls and improve venous tone, may be considered. Lifestyle modifications, including regular exercise, leg elevation, and weight management, are also crucial components of CVI management. Compression therapy, rather than Furosemide, is the cornerstone of treatment for chronic venous insufficiency, as it directly addresses the pathophysiology of the condition and improves quality of life 1.
From the Research
Furosemide (Lasix) in Chronic Venous Insufficiency
- Furosemide is a diuretic that can reduce swelling and pain in the short term, but it may not offer long-term benefits for chronic venous insufficiency (CVI) 2.
- A study found that the use of furosemide (20mg) was associated with continued swelling in patients with CVI, even after endovenous procedures 3.
- The use of dual diuretics, including furosemide, was also associated with persistent swelling in patients with CVI 3.
- However, there is no clear evidence that furosemide is beneficial in the treatment of CVI, and its use may not be recommended as a primary treatment option 2, 3, 4, 5, 6.
- Compression therapy, pharmacologic agents, and catheter-based techniques have shown promise in the management of CVI, but the role of furosemide in this context is unclear 2, 4, 5, 6.
Alternative Treatment Options
- Compression therapy is a mainstay of treatment for CVI and has been shown to be effective in reducing venous hypertension and retarding the development of inflammation and pathologic skin changes 2, 5.
- Pharmacologic agents, such as topical steroid creams, may reduce swelling and pain in the short term, but their long-term benefits are unclear 2.
- Catheter-based techniques, such as endovenous ablation and iliac vein stenting, have shown promise in the treatment of CVI, but their effectiveness may be influenced by various clinical factors 3, 4.
- Venoactive drugs may be beneficial in patients with subjective problems and/or swelling of the lower limbs, but their use should be guided by clinical evidence and recommendations 6.