Chronic venous insufficiency

The patient should be reassured that the condition is not limb threatening and differs from the circulatory problems that are due to diabetes and peripheral arterial occlusive disease.

All patients with documented CVI should be advised to wear graded compression stockings. These stockings must be put on first thing in the morning and should be removed only when the patient is recumbent (usually just before going to bed). The importance of adherence with compression therapy must also be emphasized, as an estimated 30% to 65% of patients are nonadherent with compression therapy. The recurrence of venous leg ulcers in patients adherent with stocking use is half that in those who are nonadherent, and nonadherence is the primary cause of compression therapy failure.[22]Raju S, Hollis K, Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy. Ann Vasc Surg. 2007 Nov;21(6):790-5. http://www.ncbi.nlm.nih.gov/pubmed/17980798?tool=bestpractice.com Patients should be advised that thromboembolic disorder (TED) stockings are inadequate for controlling CVI, as they provide insufficient compression at the ankle.

Patients with severe CVI or previous ulcers should be advised that they may require lifelong graded compression stockings. Following endovenous ablation, patients are usually advised to wear compression stockings for 24 hours per day for 1-3 days, and then during the day for 1-2 weeks. Postoperatively, patients can return to normal activities, but they should avoid strenuous leg activity such as running, weighted leg exercises, or cycling for 1 week. Continued use of compression stockings during the day is recommended following ablative procedures on the superficial system if there is ongoing evidence of reflux (i.e., deep system insufficiency).