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Chapter 38. Management of Lower Extremity Venous Insufficiency

K. Barrett Deatrick, MD; Thomas W. Wakefield, MD

  • Swelling.
  • Leg heaviness.
  • Aching.
  • Cramping.
  • Skin discoloration.
  • Venous ulcers.

  • Acute deep venous thrombosis.
  • Malformation of the deep venous system.
  • Active infection.
  • Symptomatic peripheral arterial disease.
  • Cardiopulmonary comorbidities (relative).

  • The patient is usually placed in the supine position initially, with exposure of the entire affected extremity.
  • The leg should be prepared circumferentially from the inguinal ligament to the foot.
  • If necessary, the patient may be repositioned prone.
    • This is especially helpful when access to posterior perforators or the small saphenous vein is necessary.

  • A short stretch bandage is applied in the operating room, and covered with an elastic bandage.
  • For the first night, patients are allowed to walk and are instructed to elevate the leg when resting.
  • Patients are encouraged to ambulate on postoperative day 1 and to return to normal activity by 48 hours, keeping the leg elevated when resting.
  • The dressing may be removed after 48 hours; the leg should be kept clean and dry.
  • Compression stockings or wraps should be worn thereafter, with the patient continuing to elevate the legs when possible.

  • Bleeding or hematoma formation.
  • Surgical site infection.
  • Deep venous thrombosis.
  • Leg swelling.

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