From the Guidelines
Endovenous thermal ablation is the recommended treatment option for varicose veins beyond compression stockings, as it has been shown to be effective in sealing affected veins with minimal downtime and improving circulation. This procedure uses laser or radiofrequency energy to destroy damaged veins, and it is typically performed under local anesthesia. According to the most recent study 1, endovenous thermal ablation has largely supplanted surgical ligation and stripping as the main invasive method to treat varicose veins, with similar efficacy, improved early quality of life, and reduced hospital recovery.
Some key points to consider when evaluating treatment options for varicose veins include:
- The size and location of the varicose veins
- The patient's overall health and lifestyle needs
- The potential risks and benefits of each treatment option
- The recovery time and downtime associated with each procedure
Other treatment options for varicose veins beyond compression stockings include:
- Sclerotherapy, which involves injecting a solution into smaller varicose veins to cause them to collapse and fade
- Ambulatory phlebectomy, which allows for removal of larger veins through tiny incisions
- Traditional vein stripping surgery, which may be recommended for extensive varicose veins
- Newer techniques such as VenaSeal and ClariVein, which use medical adhesive or combine mechanical and chemical treatments to close veins.
It's worth noting that the choice of treatment will depend on the individual patient's needs and circumstances, and patients should discuss their options with their doctor to determine the best course of treatment. As stated in the study 1, compression sclerotherapy has been used effectively in the treatment of varicose veins, but it has worse outcomes compared to endovenous thermal ablation at 1-, 5-, and 8-year follow-ups.
In terms of specific treatment recommendations, the study 1 suggests that endovenous thermal ablation is a suitable option for patients with symptomatic varicose veins and documented valvular reflux, and it can be performed without delaying for a trial of external compression. Additionally, the study 1 notes that chemical sclerotherapy has advantages such as a lack of potential thermal injury and no need for tumescent anesthesia, but it also has potential complications such as phlebitis and residual pigmentations.
Overall, endovenous thermal ablation is a highly effective and recommended treatment option for varicose veins beyond compression stockings, and patients should discuss their individual needs and circumstances with their doctor to determine the best course of treatment 1.
From the Research
Treatment Options for Varicose Veins
Besides using compression stockings, there are several treatment options available for varicose veins. These include:
- Endovenous laser photocoagulation (EVLP) 2
- Sclerotherapy 2, 3
- Ambulatory phlebectomy 2
- Surgical ligation and stripping 2
- Radiofrequency ablation 4, 5, 6
- Foam sclerotherapy 3, 5, 6
- Endovenous laser ablation (EVLA) 3, 5, 6
Minimally Invasive Treatment Options
Minimally invasive techniques have been developed as alternatives to surgery, aiming to reduce morbidity and improve recovery time. These include:
Factors Influencing Treatment Choice
The choice of treatment modality for individual patients with varicose veins is influenced by several factors, including:
- Clinical pattern of veins 5
- Guidance from the National Institute for Health and Care Excellence 5
- Patient expectations 5
- Facilities and cost 5
- Whether treatment is carried out in the public or private sector 5
Compression Regimes After Treatment
Compression regimes after endovenous ablation for superficial venous insufficiency vary significantly among surgeons, with different combinations of bandages, pads, and compression stockings used 6. The optimal compression regime following treatment is not known and requires further research.