What is the recommended treatment for varicose veins?

From the Guidelines

Treatment for varicose veins should begin with conservative approaches, including lifestyle modifications and compression therapy, before considering more invasive options like endovenous laser treatment or radiofrequency ablation, which have been shown to be as effective as surgery with fewer complications 1.

Conservative Measures

Conservative measures for varicose veins include:

• Lifestyle modifications: elevate your legs regularly, avoid prolonged standing or sitting, exercise regularly to improve circulation, maintain a healthy weight 1
• Compression therapy: wear 20 to 30 mm Hg elastic compression stockings with a gradient of decreasing pressure from the distal to proximal extremity, although evidence for its effectiveness is limited 1
• Elevation of the affected leg: may improve symptoms in some patients 1
• Weight loss: may improve symptoms in patients who are obese 1
• Phlebotonics: horse chestnut seed extract may provide symptomatic relief, but long-term studies are lacking 1

Medical Procedures

If conservative measures do not provide relief, medical procedures may be necessary, including:

• Sclerotherapy: injection of a solution to collapse affected veins 1
• Endovenous laser treatment or radiofrequency ablation: using heat to close veins, which have been shown to be as effective as surgery with fewer complications 1
• Vein stripping (surgical removal) or phlebectomy (removal through small incisions): may be considered for more severe cases, although surgery has historically been the most widely recommended treatment option, a growing body of literature does not consistently support surgery as the best interventional treatment option 1

Considerations

The decision to proceed with treatment and the choice of treatment are based on symptoms and patient preferences, as well as considerations such as cost, potential for complications, availability of resources, insurance reimbursement, and physician training 1. Consult with a vascular specialist to determine the most appropriate treatment based on the severity of your condition and symptoms.

From the Research

Treatment Options for Varicose Veins

• Minimally invasive therapies, such as endovenous laser therapy, radiofrequency ablation, or foam sclerotherapy, are as safe and effective as conventional surgery (ligation and stripping) for the treatment of varicose veins 2, 3, 4
• Compression stockings are not recommended as the initial treatment or after surgical interventions for varicose veins 2
• Sclerotherapy and surgery both appear to have a place in the management of varicose veins, with sclerotherapy being more appropriate for patients with minor superficial varicose veins not related to reflux of the saphenous system or as a post- or adjunctive treatment to other procedures, such as surgery 3
• Endovenous laser ablation (EVLA) has been shown to have lower rates of recanalisation or persistence of reflux at six weeks and recurrence of reflux at one year compared to conventional surgery 4

Considerations for Treatment

• The type of varicose vein should govern the intervention of choice, with no single treatment universally employed 3
• The patient's preference and the physician's clinical experience should be taken into account when selecting the best treatment option 5
• Further research is needed to compare the effectiveness of different treatments for varicose veins, with longer follow-up periods and standardized outcome measurements 4

Safety and Efficacy of Treatments

• Serious adverse events are rare, while minor adverse events are more common but generally self-limiting 3
• Nerve injury remains a risk with thermal ablation, but is often transient 4
• The quality of evidence for the effectiveness of different treatments for varicose veins varies, with some studies having moderate to low quality evidence 2, 4