Venous Insufficiency of the Lower Limbs - Related Resources

Cochrane reviews

Compression stockings may improve symptoms of leg fatigue in standing workers Compression Stockings in Standing Workers.
CHIVA method appears to reduce recurrence of varicose veins and produce less bruising and nerve damage than vein stripping in the treatment of chronic venous insufficiency Chiva Method for the Treatment of Chronic Venous Insufficiency.
The evidence on the overall best treatment for varicose veins is equivocal, but surgery seems to provide a more long-term benefit compared with sclerotherapy Surgery Versus Sclerotherapy for the Treatment of Varicose Veins.
Choice of sclerosant brand, dose, formulation (foam versus liquid), local pressure dressing or the degree and length of compression appear to have no significant effect on the efficacy of sclerotherapy for varicose veins Injection Sclerotherapy for Varicose Veins.
Use of tourniquet may reduce blood loss in varicose vein surgery Tourniquet in Varicose Vein Surgery.
Sclerotherapy (with sodium tetradecyl sulfate, polidocanol or heparsal) may be more effective than placebo in the treatment of telangiectasias of the lower limbs Sclerotherapy for Varicose Veins.
There is insufficient evidence on benefit or harm of valvuloplasty in the treatment of patients with deep venous incompetence secondary to primary valvular incompetence Valvuloplasty for Deep Venous Incompetence.

Surgical management of venous ulcer including subfascial endoscopic perforator surgery (SEPS), with or without saphenous ablation, may lead to almost 90% chance of ulcer healing and a 13% chance of recurrence in the short term Subfascial Endoscopic Perforator Surgery for Venous Leg Ulcer.
Skin changes, venous ulcers, and a past history of deep vein thrombosis may suggest venous reflux. Doppler ultrasonography appears to be the best method of investigation. Surgery is may be effective for patients with sapheno-femoral of sapheno-popliteal junction incompetence. Sclerotherapy may be effective in some patients with non-saphenous varicose veins .

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London NJ, Nash R. ABC of arterial and venous disease. Varicose veins. BMJ 2000 May 20;320(7246):1391-4. [PubMed]
Sybrandy JE, van Gent WB, Pierik EG, Wittens CH. Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: long-term follow-up. J Vasc Surg 2001 May;33(5):1028-32. [PubMed]
Scavée V, Lesceu O, Theys S, Jamart J, Louagie Y, Schoevaerdts JC. Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results. Eur J Vasc Endovasc Surg 2003 May;25(5):473-5. [PubMed]
Teruya TH, Ballard JL. New approaches for the treatment of varicose veins. Surg Clin North Am 2004 Oct;84(5):1397-417, viii-ix. [PubMed]
Michaels JA, Campbell WB, Brazier JE, Macintyre JB, Palfreyman SJ, Ratcliffe J, Rigby K. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess 2006 Apr;10(13):1-196, iii-iv. [PubMed] http://www.hta.ac.uk/execsumm/summ1013.shtml
Subramonia S, Lees TA. The treatment of varicose veins. Ann R Coll Surg Engl 2007 Mar;89(2):96-100. [PubMed]

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