Venous Return

Venous return from the legs relies on the calf muscle pump, competent venous valves and respiratory pressure changes rather than cardiac output. Chronic venous insufficiency develops when valves fail and pressure rises, producing oedema, heaviness, varicosities and eventually skin changes or ulceration. Graduated compression is the mainstay of conservative management, with better evidence than any oral agent. Venoactive drugs such as micronised purified flavonoid fraction and horse chestnut seed extract show modest symptomatic benefit in Cochrane reviews. New unilateral leg swelling with pain warrants urgent assessment for deep vein thrombosis rather than symptomatic supplementation.

1) Wear graduated compression stockings, the best-evidenced conservative treatment for venous insufficiency symptoms. 2) Use the calf muscle pump — walking, heel raises and ankle pumps — which is the primary mechanism returning blood from the legs. 3) Elevate the legs above heart level for periods each day to reduce venous pressure. 4) Avoid prolonged standing or sitting without movement; break up long periods every 30-60 minutes. 5) Lose excess weight, which raises intra-abdominal pressure and impedes return. 6) Stay well hydrated and moderate salt intake to limit fluid retention. 7) Get an ankle-brachial index checked before compression if arterial disease is possible. 8) Seek urgent assessment for sudden unilateral swelling, pain or redness, which may indicate deep vein thrombosis.

• •Graduated compression stockings
• •Walking and calf raises
• •Leg elevation
• •Breaking up prolonged sitting or standing
• •Weight management
• •Hydration and salt moderation