1: Primary Prevention - Clinical CEAP C3-4 Primary Venous Disease

• In patients with clinical CEAP C3-4 disease due to primary valvular reflux, we recommend compression, 20 to 30 mm Hg, knee or thigh high (Grade 2, Level C).

2: Primary Prevention - Clinical CEAP C1-4 Post-thrombotic Venous Disease

• In patients with clinical CEAP C1-4 disease related to prior deep venous thrombosis (DVT), we recommend compression, 30 to 40 mm Hg, knee or thigh high (Grade 1, Level B).

3: Primary Prevention - Acute DVT Treatment

• As post-thrombotic syndrome is a common preceding event for venous leg ulcers, we recommend current evidence-based therapies for acute DVT treatment (Grade 1, Level B).
• We suggest use of low-molecular-weight heparin over vitamin K antagonist therapy of 3-month duration to decrease post-thrombotic syndrome (Grade 2, Level B).
• We suggest catheter-directed thrombolysis in patients with low bleeding risk with iliofemoral DVT of duration <14 days (Grade 2, Level B).

4: Primary Prevention - Education Measures

• In patients with C1-4 disease, we suggest patient and family education, regular exercise, leg elevation when at rest, careful skin care, weight control, and appropriately fitting foot wear (Best Practice).

5: Primary Prevention - Operative Therapy

• In patients with asymptomatic C1-2 disease from either primary or secondary causes, we suggest against prophylactic interventional therapies to prevent venous leg ulcer (Grade 2, Level C).