Deep Venous Disease Treatments

Treatment of patients with chronic venous insufficiency is largely guided the severity of the presenting disease and surgery tends to be reserved for those with advanced disease. Most patients with obstruction secondary to DVT/May-Thurners syndrome will need to be on blood thinning drugs. This is typically warfarin but there are several new drugs on the market.

The surgical approaches differ for obstruction and reflux where the relative success of endovascular versus open surgical techniques guides treatment decisions. The results for reflux treatment are generally worse than for obstruction.

Conservative measures include compression leg garments, wound and skin care, pharmacological therapy and exercise to improve calf muscle pump function. All have demonstrated varying degrees of effect in the management of chronic venous insufficiency.

Obstruction

The mainstay of treatment of damaged vessels high up in the leg is venoplasty (stretching of the damaged vein with a balloon) and stenting. Acceptable long term patency rates in the context of both acute and chronic disease have been reported. The role of stenting has been further highlighted by the increasing evidence to support early aggressive treatment of acute ileo-femoral DVT.

Treatment may improve with the development of venous specific stents which have replaced those largely designed for the arterial system.

Surgical correction of ileo-femoral or caval obstruction options should be reserved for those patients with significant symptoms in whom endovascular options have failed or are not possible. They do however provide a reasonable option in this group of patients provided symptoms warrant intervention.The consist of bypass procedures one of the most common of which is the Palmar procedure.

Reflux

Endovascular valves have a limited role in the treatment of deep venous disease with no proven valve technology currently available and to date disappointing results from valves that have been used.

Valve reconstruction is controversial. Some authors have published good results but the overall literature is poor.

Results of valvular reconstruction are largely better in patients with post-thrombotic disease rather than primary insufficiency.



Rehabilitation