Of note, improved ejection fraction in refluxing vessels and higher extrinsic pressures were achieved when higher pressures were exerted at the calf over the distal ankle (negative graduated compression bandage). 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 quality of life (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 and 0.6, reduced compression to 20 to 30 mm Hg is successful and safe for venous leg ulcers (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 Endovenous ablation has largely supplanted surgical ligation and stripping as the main invasive method to treat varicose veins with similar efficacy, improved early QoL, and reduced hospital recovery [7,22,23]. The 2 types of endovenous ablation are radiofrequency ablation (RFA) and endovenous laser ablation (EVLA).
Lower Extremity Chronic Venous Disease. Of note, improved ejection fraction in refluxing vessels and higher extrinsic pressures were achieved when higher pressures were exerted at the calf over the distal ankle (negative graduated compression bandage). 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 quality of life (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 and 0.6, reduced compression to 20 to 30 mm Hg is successful and safe for venous leg ulcers (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 Endovenous ablation has largely supplanted surgical ligation and stripping as the main invasive method to treat varicose veins with similar efficacy, improved early QoL, and reduced hospital recovery [7,22,23]. The 2 types of endovenous ablation are radiofrequency ablation (RFA) and endovenous laser ablation (EVLA).