Compression Therapy: Class II stockings are the mainstay of conservative treatment [10]. They act by providing extrinsic compression of the superficial and deep venous systems, supporting muscle pump function to reduce ambulatory venous pressure and reduce leg oedema. Compression can be useful at several stages of CVD including:
- in early disease to delay progression of CVD;
- in advanced disease in conjunctions with other modalities to help prevent disease progress and/or treat complications; or
- after surgical or endovenous treatment, the short term, to improve treatment outcomes.
The main issue limiting their use, particularly in early disease, is compliance with daily use of knee-length stockings required for long-term delay in progression of disease and the difficulty with donning and removing the firm stockings.
Medical Management: There is some limited evidence for the use of venoactive preparations which have demonstrated some reduction in symptoms such as muscle aches and mild oedema in early disease.[10, 15] Whilst there are numerous venoactive preparations that have been studied the agents broadly fall into 2 categories – synthetic venoactive agents, such as calcium dobesilate, and natural/herbal agents, such as Red Vine Leaf extracts. These treatments should be prescribed only after complete assessment and are commonly recommended in early CVD which may not yet meet the criteria for interventional treatment. The venoactive agents should be monitored for evidence of improvement in symptoms and ceased if there is no improvement, complications or progression of disease.