Treatment of Superficial Venous Disease of the Lower Leg

Compression therapy is an effective method for the management of symptoms related to superficial disease but it does not correct the source of reflux. When patients have a correctable source of reflux definitive treatment should also be offered unless it is contraindicated or unwanted. (1A)

We recommend against compression therapy as a prerequisite therapy for symptomatic venous reflux disease when other definitive treatments such as endovenous ablation are appropriate. (1A)

After interventional treatment, we recommend the use of a compression garment in the postoperative period. There is extra benefit to the patient in the form of reduced pain after use of compression. The compression dosage and duration is at the discretion and clinical judgment of the treating physician. (2B)

Superficial venous insufficiency is a chronic disease and as such we recommend that patients with this disease be counseled to wear a compression garment even after definite treatment has been provided. The compression dosage is at the discretion and clinical judgment of the treating physician. (2C)

We suggest the treatment of some CEAP C2 patients with isolated varices, by medical compression hose alone may be an acceptable form of treatment. A short 1-2 week trial of compression hose may be appropriate where an alternative etiology of symptoms is considered, e.g. musculoskeletal pain or neuropathy (spinal stenosis, sciatica, hip or knee arthritis, diabetic neuropathy etc). (2C)

Indications for treatment include pain or other discomfort (ie, aching, heaviness, fatigue, soreness, burning), edema, varix hemorrhage, recurrent superficial phlebitis, stasis dermatitis or ulceration. We recommend patients should be evaluated using the CEAP classification and the Venous Clinical Severity Score (VCSS). We would define medically necessary as a CEAP classification of C2 or higher. (1A)