Marked Improvement in C4 Chronic Venous Disease with Compression Therapy Alone. a Case Report

Introduction, Objectives, and/or Purpose: 1. To demonstrate skin changes resulting from chronic venous disease such as hyperpigmentation can be reversed with even conservative treatments.
Venous insufficiency and associated skin changes like pigmentation and lipodermatosclerosis are thought to be chronic and progressive. Available treatments improve symptoms and slow progression, but the skin changes are not thought to be reversible. We present a case of a patient with gradual but marked improvement of C4 chronic venous disease with use of compression therapy alone.

2. To highlight the need for high quality randomized controlled trials demonstrating the efficacy of compression therapy
Compression therapy is the mainstay of treatment of chronic venous disease. Even so there is a dearth of evidence supporting the efficacy of graduated compression stockings. The evidence that is available mainly consists of studies focusing on leg ulcer healing/recurrence and for efficacy of compression stockings in preventing/treating post thrombotic syndrome. Very few studies focus on patients with Clinical, Etiology, Anatomy, Pathophysiology (CEAP) classification C2 to C4.

Methods: A 67 year old mildly obese female presented to the vascular clinic after referral from her dermatologist with bilateral but right greater than left leg swelling and skin discoloration. She was noted to have an area of induration, woody edema and reddish brown discoloration along her right shin. She was prescribed class one graduated compression stockings. She underwent venous insufficiency duplex which revealed incompetent accessory saphenous vein with associated varices mostly in the thigh. At follow up she reported significant symptomatic improvement with compression and elected to continue conservative management.

Results: She continued to follow up at a yearly basis and was noted to have improvement in her skin changes at each visit with continued use of graduated compression stockings. At her most recent visit (about 4 and a half years after initial presentation) only a small area of hyperpigmentation was notable on her right shin.

Conclusion(s): This case shows conservative management of C4 chronic venous disease with compression therapy can be an efficacious treatment and even reverse skin changes. High quality randomized controlled trials are needed to assess efficacy of compression stockings in treatment of C2-C4 disease.