Chronic venous insufficiency

No specific measures have been shown to prevent CVI. However, avoiding prolonged sitting or standing, controlling weight, abstaining from tobacco, exercising, and intermittently elevating the leg may all be helpful. Theoretically, aggressive prophylaxis against deep vein thrombosis (DVT), particularly for patients admitted to the hospital, may reduce the incidence of CVI, as it occurs in as many as 50% of people within 5-10 years of an episode of DVT.[12]Kahn SR, Ginsberg JS. The post-thrombotic syndrome: current knowledge, controversies, and directions for future research. Blood Rev. 2002 Sep;16(3):155-65. http://www.ncbi.nlm.nih.gov/pubmed/12163001?tool=bestpractice.com Long-term treatment with low molecular weight heparin, rather than oral anticoagulation after DVT, may reduce or prevent development of post-thrombotic CVI.[13]Hull RD, Liang J, Townshend G. Long-term low-molecular-weight heparin and the post-thrombotic syndrome: a systematic review. Am J Med. 2011 Aug;124(8):756-65. https://www.amjmed.com/article/S0002-9343(11)00339-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21787905?tool=bestpractice.com Patients at high risk for CVI, such as those with a family history of varicose veins, those with a previous history of DVT, and those with an orthostatic occupation, should consider wearing graduated compression stockings.

Prolonged standing, especially in one place, should be avoided. If this is not possible, compression stockings should be worn. If obese, patients should be advised to lose weight.

Patients with severe CVI or previous ulcers generally require lifelong graded compression stockings of at least 30-40 mmHg. Adherence with compression therapy markedly reduces, but does not eliminate, long-term sequelae.