From the Guidelines
Treatment for venous insufficiency should always begin with conservative measures, including compression therapy with graduated compression stockings (20-30 mmHg or 30-40 mmHg for more severe cases), regular exercise, leg elevation, and weight loss if needed, as these approaches have been shown to improve symptoms and quality of life 1.
Conservative Measures
- Compression therapy is a first-line treatment for venous insufficiency, with a minimum pressure of 20 to 30 mm Hg recommended, and pressures of 30 to 40 mm Hg advised for more severe disease 1
- Regular exercise, such as walking or cycling, can help improve blood flow and reduce symptoms
- Leg elevation can help reduce swelling and improve blood flow
- Weight loss, if needed, can also help reduce symptoms and improve overall health
Medical Interventions
- Medications such as horse chestnut seed extract, pentoxifylline, and micronized purified flavonoid fraction may help reduce symptoms, although the evidence for their effectiveness is limited 1
- Minimally invasive procedures like endovenous thermal ablation, sclerotherapy, or phlebectomy can be considered for more severe cases, as they have been shown to be effective in improving symptoms and quality of life 1
- Traditional surgical options, such as vein stripping and ligation, may also be considered, although they are generally reserved for more severe cases or those that have not responded to other treatments 1
Important Considerations
- Patients should understand that venous insufficiency is often a chronic condition requiring ongoing management, and early intervention with compression therapy and lifestyle modifications can prevent progression and complications like venous ulcers or deep vein thrombosis 1
- The choice of treatment should be based on the severity of symptoms, patient preferences, and the presence or absence of deep venous insufficiency, as well as other factors such as cost, potential for complications, and availability of resources 1
From the Research
Treatment Options for Venous Insufficiency
The treatment options for venous insufficiency include:
- Compression therapy using pumps, bandaging, and/or graded compression stockings, which is the mainstay of treatment for chronic venous insufficiency (CVI) 2
- Pharmacologic agents such as diuretics and topical steroid creams to reduce swelling and pain short term 2
- Herbal supplements, such as horse chestnut seed extract containing aescin, which may reduce the inflammatory response to venous hypertension 2
- Endovascular and surgical techniques aimed at treatment of primary and secondary venous valvular reflux, which have been shown to improve venous hemodynamics promoting healing of venous ulcers and improving quality of life 2
- Minimally invasive alternative treatments for varicose veins, including:
- Venous thermal ablation using laser or radiofrequency 3, 4, 5
- Endovenous chemical ablation 4
- Ultrasound-guided foam sclerotherapy, which is a venous injection of sclerosing foam controlled by Doppler ultrasound 3, 4, 6
- Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy, which are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency 6
Considerations for Treatment
When considering treatment options, it is essential to take into account the clinical and anatomical factors of the patient, as well as the presence of perforating vein insufficiency, which may affect the treatment outcome 6. Additionally, certain conditions, such as pregnancy, active deep vein thrombosis, poor health with limited mobility, and severe peripheral vascular disease, are contraindications for thermal and chemical ablation 4.
Effectiveness of Treatment Options
Studies have shown that endovenous laser ablation and foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups 6. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency 6.