Compression therapy for the treatment of chronic venous insufficiency
- David G Armstrong, DPM, MD, PhD
David G Armstrong, DPM, MD, PhD
- Professor of Surgery
- Director, Southern Arizona Limb Salvage Alliance (SALSA)
- University of Arizona College of Medicine
- Andrew J Meyr, DPM
Andrew J Meyr, DPM
- Associate Professor
- Temple University School of Podiatric Medicine
- Section Editors
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Sciences Center - Dallas Campus
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
Compression therapy remains the cornerstone of management for patients with chronic venous insufficiency (venous valvular reflux). Chronic venous disease is commonly stratified using the CEAP (Clinical, Etiology, Anatomy, Pathophysiology) classification, which grades venous disease based on the presence of dilated veins, edema, skin changes, or ulceration (table 1). (See "Classification of lower extremity chronic venous disorders", section on 'CEAP classification'.)
Chronic venous insufficiency is defined as CEAP 3 to 6 and represents advanced venous disease . Chronic venous insufficiency 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 . Annual costs in the United States for the treatment of venous ulcers are estimated at more than $2 billion from costs related to frequent physician visits, care provided by nurses, compression therapy and wound care products, and potentially hospitalization.
Medical compression therapy includes garments or devices that provide static or dynamic mechanical compression to a body region. For the treatment of lower extremity chronic venous insufficiency, static compression includes compression hosiery and compression bandages. Dynamic (intermittent) compression therapy in the form of intermittent pneumatic compression pumps and sleeves may be useful under select circumstances.
The pathophysiology, clinical features and diagnosis, and management of chronic venous disease are discussed elsewhere. (See "Overview and management of lower extremity chronic venous disease".)
Compression therapy remains the cornerstone of management for patients with chronic venous disease [3,4]. For patients with venous ulceration, the benefits of long-term compression therapy (stockings or bandages) have repeatedly been demonstrated in randomized trials . Healing rates as high as 97 percent can be achieved in those who are compliant with therapy . Patients with edema, weeping, or skin changes in the absence of ulceration also benefit. The goals of treatment are ulcer healing, and reduction of extent of edema, lipodermatosclerosis, and pain. Other treatments and local wound care are discussed separately. (See "Medical management of lower extremity chronic venous disease".)
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- STATIC COMPRESSION THERAPY
- Compression hosiery
- - Prescription
- - Use and care of compression hosiery
- Before placement
- Care of hosiery
- Compression bandages
- - Application
- - General tips for compression bandage placement
- Multilayer compression bandages
- - Padding (layer 1)
- - Crepe bandage (layer 2)
- - Extensible elastic bandage (layer 3)
- - Cohesive elastic bandage (layer 4)
- Unna boot
- - Patient instructions and follow-up
- Adjustable compression
- DYNAMIC COMPRESSION THERAPY
- CHOICE OF INITIAL THERAPY
- Skin necrosis
- Fungal infection
- Contact dermatitis
- COST OF COMPRESSION THERAPIES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS