What is the treatment for varicose veins?

From the Guidelines

The most effective treatment for varicose veins is endovenous ablation, which has been shown to have similar efficacy to surgical ligation and stripping, but with improved early quality of life and reduced hospital recovery 1. When considering treatment options for varicose veins, it's essential to prioritize morbidity, mortality, and quality of life. The current evidence suggests that endovenous ablation, including radiofrequency ablation (RFA) and endovenous laser ablation (EVLA), is a highly effective treatment for varicose veins.

Key Points to Consider:

• Endovenous ablation has been shown to have occlusion rates of 91% to 100% within 1-year post-treatment 1.
• EVLA and RFA have been found to have reduced rates of bleeding, hematoma, and wound infection compared to surgery 1.
• Compression therapy, with a minimum pressure of 20 to 30 mm Hg, is also a recommended initial treatment for varicose veins, as it can help reduce venous stasis and improve venous pumping function 1.

Treatment Approach:

1. Start with conservative measures: Wear compression stockings daily (20-30 mmHg pressure), elevate legs above heart level for 15-30 minutes, 3-4 times daily, exercise regularly, maintain a healthy weight, and avoid prolonged standing or sitting.
2. Consider medical treatments: Endovenous ablation (RFA or EVLA) for larger varicose veins, sclerotherapy for small to medium-sized veins, and phlebectomy for larger surface veins.
3. Medications: Diosmin (500 mg twice daily) or horse chestnut seed extract (300 mg twice daily) may help improve vein tone and reduce symptoms. It's crucial to consult with a vascular specialist to determine the most appropriate treatment plan for each individual case, taking into account the severity of the varicose veins, overall health, and lifestyle.

From the FDA Drug Label

Asclera® (polidocanol) is indicated to sclerose uncomplicated spider veins (varicose veins ≤1 mm in diameter) and uncomplicated reticular veins (varicose veins 1 to 3 mm in diameter) in the lower extremity. For spider veins (varicose veins ≤1 mm in diameter), use Asclera 0.5%. For reticular veins (varicose veins 1 to 3 mm in diameter), use Asclera 1%. Use 0.1 to 0.3 mL per injection and no more than 10 mL per session.

The treatment for varicose veins, specifically uncomplicated spider veins (≤1 mm in diameter) and uncomplicated reticular veins (1 to 3 mm in diameter), is sclerotherapy using polidocanol (Asclera). The recommended dosage is:

• 0.5% solution for spider veins
• 1% solution for reticular veins
• 0.1 to 0.3 mL per injection, with a maximum of 10 mL per session 2, 2, 2.

From the Research

Treatment Options for Varicose Veins

The treatment for varicose veins can vary depending on the severity of the condition and the patient's overall health. Some of the available treatment options include:

• Conservative measures, such as medications, compression stockings, and lifestyle changes 3
• Minimally invasive procedures, such as sclerotherapy or endoluminal ablation 3, 4
• Invasive surgical techniques, including saphenous vein stripping, ligation of the saphenofemoral junction, and ambulatory phlebectomy 5
• Hybrid treatments, which combine two or more therapies 3
• Endovenous therapies, including endovenous laser therapy, radiofrequency ablation, and endovenous foam sclerotherapy 5, 4

Factors to Consider When Choosing a Treatment

When selecting a treatment for varicose veins, several factors should be taken into account, including:

• The patient's reason for consulting and clinical condition 6
• Anatomical and hemodynamic characterization of the varicose veins by means of duplex ultrasound 6
• The potential risks and benefits of each treatment option 5, 7
• The patient's overall health and medical history 3

Efficacy and Safety of Treatment Options

Studies have shown that various treatment options can be effective in treating varicose veins, including:

• Surgery, which has been associated with a nonsignificant reduction in the risk of varicose vein recurrence compared with liquid sclerotherapy and endoluminal interventions 7
• Endovenous therapies, which have demonstrated short-term effectiveness and safety 4, 7
• Minimally invasive procedures, which are associated with less periprocedural disability and pain compared with surgery 7