The Lower Extremity Venous System Part III: Nonoperative Treatment of Chronic Venous Insufficiency

Nonoperative therapy has clearly been the hallmark of treatment for chronic venous insufficiency (CVI) and venous ulceration for decades. Although bed rest with limb elevation is universally accepted as effective therapy for venous ulceration, long-term bed rest is impractical for most patients. Today this form of therapy is typically used only as a short-term solution to a refractory or enlarging ulcer. The goal of nonoperative therapy of venous ulceration is to promote healing of existing ulcers and prevent their recurrence while allowing the patient to maintain insofar as possible a normal ambulatory status. In Part III of this series of articles on venous disease, we will update the current status of compres-sion, pharmacologic, and topical therapies and our impression of their relative roles in the treatment of CVI and venous ulceration. COMPRESSION THERAPY Compression therapy remains the primary treatment for CVI despite an abun-dance of recent interest in both ablativel and reconstructive2,3 venous surgery The mechanism(s) of benefit of compression therapy in patients with CVI and