What is the management for chronic venous insufficiency with or without ulcers?

Chronic venous insufficiency (CVI) is a condition that occurs when the venous system is incapable of adequately returning blood from the lower extremities to the heart, leading to symptoms such as leg swelling, pain, and, in severe cases, ulceration. The management of CVI primarily focuses on improving venous return, alleviating symptoms, and preventing complications like ulcers.

Class 2-3 compression stockings are considered the gold standard in the non-surgical management of chronic venous insufficiency. These stockings apply graduated compression that is higher at the ankle and decreases toward the knee or thigh, promoting venous return and reducing venous pressure. The effectiveness of these stockings in reducing symptoms and the risk of progression to ulcers is well-documented. This conservative approach is particularly beneficial as it is non-invasive and can significantly improve patients' quality of life when they are consistently used.

In contrast, while surgical intervention may be necessary in certain cases that are severe or unresponsive to conservative measures, it is typically not the first-line management for chronic venous insufficiency. Similarly, pharmacological therapy does play a role in some cases, especially for managing symptoms or underlying conditions, but it does not address the fundamental problem of venous return in the same