Chronic venous insufficiency refers to the presence of edema, skin changes, or ulceration and represents advanced venous disease (CEAP 3 to 6). Chronic venous insufficiency (venous valvular reflux) is the most common cause of lower extremity ulceration, accounting for up to 80 percent of the approximately 2.5 million leg ulcer cases in the United States . Compression therapy remains the cornerstone of management for patients with venous ulceration. The goals of treatment are ulcer healing and reduction of edema, extent of lipodermatosclerosis and pain. Healing rates as high as 97 percent can be achieved in patients who are compliant . Compression bandaging systems are available as either inelastic bandages, or elastic compression systems varying between one and four layers.
Bandaging systems available for the treatment of lower extremity chronic venous insufficiency are reviewed. The epidemiology, classification, clinical presentation, diagnosis, pathophysiology, and other forms of medical management of chronic venous disease are discussed in an overview topic and separate topic reviews. (See "Overview and management of lower extremity chronic venous disease".)
Compression bandages are indicated in patients with:
- Significant edema due to chronic venous insufficiency
- Weeping due to chronic venous insufficiency
- Venous ulceration without cellulitis or significant pain
Contraindications — It is important to differentiate an ulcer due to chronic venous insufficiency from ischemic ulceration. In patients with non-palpable pulses or risk factors for peripheral artery disease, vascular evaluation including ankle-brachial index should be performed. Peripheral artery disease and chronic venous disease frequently coexist. (See "Clinical assessment of wounds", section on 'Differentiation of chronic ulcers'.)