From the Research
The workup for chronic venous hypertension begins with a thorough history and physical examination, focusing on risk factors and characteristic findings such as edema, skin changes, and varicosities, and management should prioritize phlebectomy over sclerotherapy for varicose veins, as shown in a recent comparative study 1. The diagnostic evaluation should include duplex ultrasound to assess venous reflux and obstruction, which is the gold standard non-invasive test. Additional imaging may include venography, CT venography, or MR venography if more detailed anatomical information is needed. Management starts with conservative measures including:
- Leg elevation
- Regular exercise
- Compression therapy (30-40 mmHg graduated compression stockings worn daily) Weight loss should be encouraged for overweight patients. Pharmacologic options include venoactive drugs such as micronized purified flavonoid fraction (MPFF, 500 mg twice daily) or horse chestnut seed extract (300 mg twice daily), which can reduce symptoms and edema. For patients with venous ulcers, appropriate wound care with moist wound healing principles and infection control is essential. Interventional treatments for significant reflux include endovenous thermal ablation (laser or radiofrequency), sclerotherapy, or surgical options like high ligation and stripping for the great saphenous vein. Venous stenting may be considered for significant venous obstruction, as discussed in a review on contemporary management of deep venous thrombosis 2. These interventions aim to reduce venous pressure, improve symptoms, and prevent complications like ulceration. Regular follow-up is important to monitor disease progression and treatment efficacy, and lifestyle interventions such as regular physical exercise, body weight management, and healthy dietary patterns can also play a role in prevention and treatment of hypertension, as highlighted in a review on lifestyle interventions 3.