Finally, we proceed in a step-wise approach to the treatment of venous valvular reflux. Usually, instructions to patients with venous insufficiency are brief: elevate the legs and wear support stockings. The patient is then left with trying to work out the details only to find that coping with gravity in an upright lifestyle can be vexing. The guidelines presented here are meant to help to achieve satisfactory control of the condition with minimal interference with lifestyle.
The person with symptoms from chronic venous insufficiency must accept certain truisms about his or her situation. Because the determining factor is the effect of gravity on a disabled anti-gravitational system, it is self-evident that the principles of management must center on physical measures rather than on pharmaceuticals. Therefore, attention is focused on relieving the increase of hydrostatic pressure of upright activity. At the same time, the patient should not expect that the defective valves will heal; venous insufficiency is a lifelong condition. Furthermore, no pill can be prescribed that will neutralize the effect of gravity. The treatment regimen must be considered a long-term commitment to contain the symptoms and the damage to tissue rather than to eliminate its cause.
Timeliness of treating venous insufficiency is of utmost importance. In the early stages of venous valvular reflux, interventions can be applied easily when there is an excellent chance of arresting injury to tissues. It is tragic that delayed diagnoses are commonplace and that patients often do not begin effective treatment until the condition has become far advanced, sometimes after many years of noticeable signs and symptoms. More often than not, physicians who are accustomed to managing this condition are presented with disabling complications have already become well established, and the skin and contour of the lower leg have become permanently disfigured.
In this setting, it is often true that the initiating event—a bout of thrombophlebitis—cannot be remembered and the real nature of the condition escapes recognition. Furthermore, there is a common attitude among health care professionals that little can be done to help people in the more advanced stages of venous insufficiency, an attitude which has a demoralizing effect on the long-suffering patient. A treating physician or other provider not familiar with the subtleties of compression garments and other modalities helpful for controlling the symptoms can delay effective care.
The role of medications must be addressed. Patients with swelling of the legs from whatever reason seem to receive drug treatment first. By the time physiological treatment has been initiated for venous insufficiency, nearly all patients have already tried diuretics. These agents are notoriously ineffective in this syndrome of localized edema; they may even be harmful because of their adverse effects on the blood (reduction of volume, increased lipid levels, decreased body potassium, and rise in blood sugar in diabetics). Nevertheless, there are times when a diuretic is ...