heart and blood vessel disorders
Chronic Venous Insufficiency and Post Thrombotic Syndrome
Treatment of Chronic Venous Insufficiency
Treatment involves Leg elevation Compression using properly applied bandages, graduated compression stockings, and/or intermittent pneumatic compression devices Wound care Elevating the legabove the level of the heart decreases pressure in the veins, and should be done for 30 minutes or longer at least 3 times per day. Compressionis effective and used for all people to help reduce swelling and discomfort. Elastic bandages are used first. Once edema decreases and ulcers begin to heal, people can use commercial graduated compression stockings. Such stockings are available with different amounts of pressure (highest pressure at ankles and lower pressures higher on the leg). Higher pressure stockings are more effective for severe problems but are more uncomfortable. Stockings should be put on when people awaken, before leg edema worsens with activity, and worn all day. Many people have difficulty using the stockings regularly. People may consider the stockings unattractive. More active people may consider stockings irritating or restricting. Some people may have difficulty putting them on. Intermittent pneumatic compression (IPC) uses a pump to repeatedly inflate and deflate hollow plastic leggings. IPC squeezes blood and fluid out of the lower legs but is cumbersome. IPC therapy is used when compression stockings are not effective or the person in unable to tolerate them. Wound careis important to heal leg ulcers. Various dressings have been developed that can be left under compression stockings for several days to a week. The Unna boot dressing useszinc oxide–impregnated bandages. Other dressings provide a moist environment for wound healing and promote growth of new tissue. Medications and surgery do not help chronic venous insufficiency, although skin grafting can be a last resort for skin ulcers that have not healed with other measures. However, the grafted skin will reulcerate unless the person consistently follows leg elevation and compression instructions. 