[Conservative therapy in varicose symptom complex].
This article deals with the conservative management of light and severe forms of varicosities as well as chronic venous insufficiency along with subjective symptoms and trophic skin changes. Approximately 40% of the population shows minor forms and another 10% shows major forms of varicosities. The prevalence of advanced stages of chronic venous insufficiency is approximately 3%. Compression therapy represents the mainstay of anti-edema treatment. Elastic bandages are mainly used during the acute phase, and compression stockings are rather recommended to maintain the result. The differences of short stretch and long stretch bandages, as well as the classes of compression therapy are discussed. Physical therapy, such as joint mobilization, ambulation exercises, and lymph drainage may further support edema reduction in severe cases. Edema-protective drugs can be justified as adjuvant treatment. The pharmacology and action of these substances has been further elucidated by both laboratory and clinical studies. It has been shown that the continuous use of these substances during 8-12 weeks can reach the anti-edematous effect of class II-stockings. Sclerotherapy is especially useful in the treatment of smaller caliper reticular varicosities and teleangiectatic veins. The development of new vascular lasers with a long pulse duration has added to the options in the treatment of leg teleangiectasias, although these expensive techniques cannot be regarded a standard therapy. Advanced stages of chronic venous insufficiency are also amenable to conservative treatment. In these cases, an exact vascular examination is highly recommended. Interventional treatment of relevant peripheral arterial disease and of superficial venous insufficiency can impressively improve the quality of life of these patients, even at an elderly age. Moreover, the role and differential indication of synthetic dressings in the local therapy of chronic leg ulcers is explained in-depth.
Dermatologische Klinik und Poliklinik, Universitätsspital Zürich. jhafner@derm.unizh.ch
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Hafner
D001458:Bandages; D003131:Combined Modality Therapy; D006801:Humans; D008209:Lymphedema / Q000628:therapy; D026741:Physical Therapy Modalities; D015911:Sclerotherapy; D016896:Treatment Outcome; D014648:Varicose Veins / Q000628:therapy*; D014689:Venous Insufficiency / Q000628:therapy*