A middle-age woman has right leg and foot nonpitting edema associated with dermatitis and hyperpigmentation. The diagnosis of chronic venous insufficiency is made. What is the treatment of choice?

The mainstay of treatment of chronic venous insufficiency and its complication, venous stasis ulceration, is conservative management. Elastic stocking support, frequent elevation of the legs, and avoidance of prolonged sitting and standing is used for venous insufficiency in the absence of ulceration. If venous stasis ulcers develop, then paste boots (e.g., Unna's boots) are used along with appropriate bed rest and foot elevation until the ulcer heals. Patients whose ulcers fail to heal after such conservative management may need perforator vein ligation. Skin grafting should be considered for chronic stasis ulcers that are large, and perforator incompetence has been treated. Venous reconstruction procedures, including valvuloplasty, can be useful for a selected group of patients, especially those with venous claudication to less than half a block, that have been treated with all the procedures above, including stripping and ligation. Unlike previous opinions, superficial venous stripping and ligation is not always contraindicated in the presence of chronic venous insufficiency and even previous history of deep vein thrombosis.