Treatment of Chronic Venous Disorders
Chronic venous disease of the lower extremities is one of the most common diseases in Western Europe and the United States. The nonoperative approach to patients with chronic venous disease includes lifestyle modification, compression, and pharmacologic therapies. Compression therapy has been shown to be an essential component of the care of patients with chronic venous disease (C2-C6). A number of compression garments are available: gradient elastic stockings, the CircAid garment, paste gauze boots, layered elastic and nonelastic compression bandages, and intermittent pneumatic compression devices. High-grade compression therapy is the mainstay of treatment of patients with advanced chronic venous disease (C4-C6). Gradient compression stockings (30-40 mm Hg) have been shown to be effective not only in ulcer healing but mostly in reducing the risk of ulcer recurrence. The ESCHAR trial (comparison of surgery and compression with compression alone in chronic venous ulceration) showed that surgical ablation of refluxing veins may be beneficial in addition to compression therapy to prevent ulcer recurrence. Pharmacologic therapy in venous disease is directed toward symptom control in patients with mild to moderate chronic venous disease and the treatment of venous ulcers. Micronized purified flavonoid fraction (MPFF) is a useful adjunct in the treatment of large and long-standing ulcers.
