An understanding of venous pathophysiology is helpful in managing deep venous insufficiency. Examination of the patient after standing for 10 minutes by searching for perforator tenderness and milking away the edema will reveal incompetent perforators. A sponge pump improves calf pumping and reduces local tissue damage from the systolic peak pressures of walking. It is an invaluable aid in treatment. The combination of high ligation of the superficial system and compression sclerotherapy for the perforators gives excellent control. Compression sclerotherapy can be readily repeated as necessary. Patients with severe deep venous insufficiency should always be advised to wear a surgical support stocking indefinitely.
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