From the Guidelines
The best initial treatment for chronic venous insufficiency is compression therapy, with a recommended minimum pressure of 20 to 30 mm Hg, and 30 to 40 mm Hg for more severe disease. This approach is supported by recent evidence from the Journal of the American College of Radiology, which highlights the benefits of compression therapy in reducing venous stasis, improving venous blood flow velocity, and enhancing lymphatic drainage 1.
When implementing compression therapy, it is essential to consider the type of compression device and the pressure gradient. The use of negative graduated compression bandages, which exert higher pressures at the calf over the distal ankle, has been shown to achieve improved ejection fraction in refluxing vessels and higher extrinsic pressures compared to graduated compression bandages 1.
Key considerations for effective compression therapy include:
- Proper fitting and education to ensure adherence
- Detailed instructions on the use of compression devices
- Regular monitoring of symptoms and adjustment of compression pressures as needed
- Combination with other conservative measures, such as elevation of the legs, regular exercise, and maintenance of a healthy weight
It is also important to note that while compression therapy has been shown to be effective in preventing ulcer recurrence and healing ulcers, the evidence for its use in earlier stages of chronic venous insufficiency (C2 to C4 disease) is limited 1. However, given the potential benefits and relatively low risks, compression therapy remains a recommended initial treatment approach for chronic venous insufficiency.
From the Research
Initial Treatment for Chronic Venous Insufficiency
The best initial treatment for chronic venous insufficiency (CVI) is compression therapy, which can be achieved through various methods, including:
- Compression stockings: These are considered the mainstay of treatment for CVI and have been shown to improve symptoms and quality of life 2, 3, 4, 5.
- Inelastic compression wraps: These may be an alternative for patients who cannot tolerate compression stockings and have been shown to improve quality of life and reduce symptoms 2.
- Graduated compression stockings: These are a type of compression stocking that provides graduated compression, with the highest pressure at the ankle and decreasing pressure as you move up the leg 4, 5.
Effectiveness of Compression Therapy
Studies have consistently shown that compression therapy is effective in improving symptoms and quality of life for patients with CVI, including:
- Reducing swelling and pain 3, 5
- Improving activity tolerance and reducing depression and sleeping problems 5
- Improving quality of life, as measured by the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) 2
Adherence to Treatment
Adherence to compression therapy can be a challenge, with studies showing that up to 44.2% of patients may not adhere to treatment due to various reasons, including financial constraints, pain, and ignorance of the need to wear compression stockings 4.
Safety of Compression Stockings
Compression stockings have been shown to be safe for patients with CVI, even those with peripheral artery disease (PAD), as long as the ankle-brachial index is ≥ 0.5 3.