Improved pressures and ejection fractions were also observed when placing the compression bandage over the calf versus the distal leg [18]. Until recently, it had been widely accepted that treatment failure typically results from noncompliance [16,17]. However, 2 high-quality systematic reviews have concluded that the current published data are inadequate. The weakness in the data relates to the reliance on surrogate outcomes and subjective clinical improvement. Though present, few data demonstrate correlation with QoL improvement with routine use of compression alone [15]. Adherence should nonetheless be encouraged with proper fitting, education, and detailed instructions [19,20]. Despite the minimal evidence regarding C2 to C4 disease, there is evidence that compression therapy has value in C5 (preventing ulcer recurrence) and C6 disease (healing ulcers) [15]. Mosti and Partsch [18] demonstrated that 30 to 40 mm Hg inelastic compression is better than elastic bandaging for wound healing. They also showed that for ankle-brachial indices between 0.9 to 0.6, reduced compression to 20 to 30 mm Hg is successful and safe for VLU healing. Velcro inelastic compression was noted to be as good as 3- or 4-layer inelastic bandages. Caution is advised, however, when the ankle-brachial index is <0.6 because it indicates an arterial anomaly needing revascularization [21]. Saphenous Vein Ablation Multiple recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery [12,24-26]. When compared to surgery, EVLA had fewer rates of bleeding, hematoma, and wound infection [24]. EVLA and RFA were also noted to have reduced rates of paresthesia compared to surgery [27]. A meta- analysis pooling 52 studies of both RFA and EVLA demonstrated postprocedural thrombotic events infrequently; DVT occurred in 0.3% of cases, and pulmonary embolism occurred in 0.1% of cases [28].
Lower Extremity Chronic Venous Disease. Improved pressures and ejection fractions were also observed when placing the compression bandage over the calf versus the distal leg [18]. Until recently, it had been widely accepted that treatment failure typically results from noncompliance [16,17]. However, 2 high-quality systematic reviews have concluded that the current published data are inadequate. The weakness in the data relates to the reliance on surrogate outcomes and subjective clinical improvement. Though present, few data demonstrate correlation with QoL improvement with routine use of compression alone [15]. Adherence should nonetheless be encouraged with proper fitting, education, and detailed instructions [19,20]. Despite the minimal evidence regarding C2 to C4 disease, there is evidence that compression therapy has value in C5 (preventing ulcer recurrence) and C6 disease (healing ulcers) [15]. Mosti and Partsch [18] demonstrated that 30 to 40 mm Hg inelastic compression is better than elastic bandaging for wound healing. They also showed that for ankle-brachial indices between 0.9 to 0.6, reduced compression to 20 to 30 mm Hg is successful and safe for VLU healing. Velcro inelastic compression was noted to be as good as 3- or 4-layer inelastic bandages. Caution is advised, however, when the ankle-brachial index is <0.6 because it indicates an arterial anomaly needing revascularization [21]. Saphenous Vein Ablation Multiple recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery [12,24-26]. When compared to surgery, EVLA had fewer rates of bleeding, hematoma, and wound infection [24]. EVLA and RFA were also noted to have reduced rates of paresthesia compared to surgery [27]. A meta- analysis pooling 52 studies of both RFA and EVLA demonstrated postprocedural thrombotic events infrequently; DVT occurred in 0.3% of cases, and pulmonary embolism occurred in 0.1% of cases [28].