Current Therapeutic Interventions in Lower Extremity Venous Insufficiency: a Comprehensive Review

• Published in: Current pain and headache reports Vol. 23; no. 3; p. 16
• Main Authors: Novak, Caroline J., Khimani, Namrata, Kaye, Alan D., Jason Yong, R., Urman, Richard D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2019; Springer Nature B.V
• Subjects: Ablation; Anesthesiology; Compression therapy; Edema; Humans; Hypertension; Internal Medicine; Leg ulcers; Lower Extremity - blood supply; Medicine; Medicine & Public Health; Other Pain (A. Kaye and N. Vadivelu; Pain management; Pain Medicine; Quality of life; Sclerotherapy; Section Editors; Surgery; Surgical outcomes; Topical Collection on Other Pain; Ultrasonic imaging; Varicose veins; Vein & artery diseases; Venous Insufficiency - therapy; Varicose vein; Chronic venous disease; Treatment; Radiofrequency; Ablation; Laser
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-019-0759-z

Purpose of Review Chronic venous disease (CVD), although affecting up to 40% of the US population, is often underdiagnosed by healthcare professionals due to an incomplete understanding of the presenting symptoms. CVD is a common cause of lower extremity pain and discomfort, including aching, cramping, tingling, burning, swelling, heaviness, restlessness, and fatigue, and may lead to significant morbidity if left untreated. The negative impact of CVD on quality of life is well established and the optimization of management strategies is an important area of evolving research. Recent Findings Management of CVD has rapidly evolved over the last two decades with the development of minimally invasive endovenous ablative techniques, now the mainstay of treatment. We discuss the data supporting various methods of CVD treatment with an emphasis on the impact on patient comfort and quality of life. Summary Both radiofrequency ablation (RFA) and endovenous laser therapy (EVLA) are excellent options for treatment of lower extremity venous disease, but RFA is associated with less post-procedure discomfort. Ultrasound-guided foam therapy is best reserved for the adjuvant setting or for patients ineligible for RFA or EVLA.