From the Guidelines
Untreated large varicose veins can lead to severe complications, including chronic venous insufficiency, skin changes, bleeding, superficial thrombophlebitis, and venous ulcers, emphasizing the need for prompt treatment to improve morbidity, mortality, and quality of life. The potential complications of large varicose veins are numerous and can significantly impact a patient's quality of life. Treatment options range from conservative approaches to invasive procedures. Conservative management includes:
- Compression stockings (20-30 mmHg or 30-40 mmHg) to provide relief from discomfort and reduce venous stasis 1
- Regular exercise to improve circulation
- Leg elevation to reduce swelling
- Weight loss if needed to decrease pressure on the veins
Minimally invasive treatments include:
- Sclerotherapy, where solutions like polidocanol or sodium tetradecyl sulfate are injected to collapse the vein
- Endovenous thermal ablation using laser or radiofrequency to seal the vein
- Medical adhesives like cyanoacrylate to close the vein
Surgical options include:
- Ambulatory phlebectomy for removing surface veins through tiny incisions
- Traditional vein stripping for severe cases
Pain medications like NSAIDs can help manage discomfort, while topical treatments containing horse chestnut extract may provide symptomatic relief 1. Treatment choice depends on vein size, location, and patient factors, with most procedures being outpatient with quick recovery times. These interventions work by either removing or closing abnormal veins, redirecting blood flow to healthy veins and reducing pressure in the venous system. According to a recent study, endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are as effective as surgery for great saphenous vein varices 1.
Given the potential complications and the availability of effective treatment options, it is recommended that patients with large varicose veins undergo treatment to prevent long-term morbidity and improve quality of life. The choice of treatment should be individualized based on the patient's specific condition, preferences, and medical history. As noted in a 2023 study, the five-year results of a randomized clinical trial comparing conventional surgery, endovenous laser ablation, and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins showed promising outcomes for minimally invasive procedures 1.
From the Research
Complications of Untreated Large Varicose Veins
- Chronic venous insufficiency (CVI) can lead to advanced symptoms like oedema, skin changes, or leg ulcers 2
- Varicose veins can increase the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE), especially in patients with additional risk factors such as previous venous thromboembolism, malignancy, estrogen use, pregnancy, and obesity 3
- Untreated varicose veins can lead to venous ulceration and venous thrombosis 4
- Chronic venous disease (CVD) can progress to CVI and lead to venous leg ulcer (VLU) if not adequately treated 5
Treatment Options for Large Varicose Veins
- Compression therapy by bandages or medical compression stockings is essential for initial treatment and maintenance therapy 2
- Correction of venous refluxes by surgery or endovenous procedures, including echo-guided foam sclerotherapy, should be considered in every single case 2
- Minimally invasive treatment methods, such as thermal (radiofrequency ablation, endovenous laser ablation, steam ablation) and nonthermal (sclerotherapy, echosclerotherapy, Clarivein, Sapheon) methods, are available and have shown satisfactory early outcomes 4
- High ligation and stripping (HL/S) is associated with higher anatomic closure rates at 30 days and 5 years when compared with radiofrequency ablation and ultrasound-guided foam sclerotherapy (UGFS) 6
- Endovenous laser ablation (EVLA) is associated with lower anatomic closure rates at 30 days than cyanoacrylate closure (CAC) and higher rates at one and 5 years when compared with UGFS 6