From the Guidelines
Treatment for painful varicose veins should prioritize endovenous ablation, specifically endovenous laser ablation (EVLA) or radiofrequency ablation (RFA), as these methods have shown similar efficacy to surgical ligation and stripping, with improved early quality of life and reduced hospital recovery 1.
Conservative Measures
Before proceeding to medical interventions, conservative measures can be employed to alleviate pain and prevent worsening of varicose veins. These include:
- Lifestyle modifications such as regular exercise, elevating the legs, avoiding prolonged standing or sitting
- Wearing compression stockings (20-30 mmHg pressure) during the day and removing them at night
- Over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) to manage discomfort
Medical Interventions
For more severe cases, medical procedures may be necessary, including:
- Sclerotherapy (injection of a solution to collapse the vein)
- Endovenous laser treatment
- Radiofrequency ablation
- Surgical removal (vein stripping) These treatments work by either closing off or removing the problematic veins, redirecting blood flow to healthier veins. The choice of treatment depends on the severity of symptoms, size and location of the varicose veins, and individual patient factors.
Rationale
Varicose veins develop when vein valves malfunction, allowing blood to pool and veins to enlarge, which explains why treatments focus on either supporting proper blood flow or eliminating the damaged veins. Recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery, with fewer rates of bleeding, hematoma, and wound infection 1.
From the Research
Treatment Options for Painful Varicose Veins
- Conservative measures such as medications, compression stockings, and lifestyle changes are available for the treatment of varicose veins 2
- Minimally invasive procedures like sclerotherapy or endoluminal ablation can also be used to treat varicose veins 2
- Invasive surgical techniques and hybrid approaches (combination of ≥1 therapies) are also options for the treatment of varicose veins 2
- Emerging endovenous therapies, including endovenous laser therapy, radiofrequency ablation, and endovenous foam sclerotherapy, have shown similar efficacy in the treatment of varicose veins compared with more invasive surgical procedures, with lower complication rates and less time lost from work 3
Prevention and Management
- Prolonged standing and obesity are major reasons for varicose vein disease, and preventive measures such as regular yoga/exercise and consumption of certain fruits and vegetables can help improve quality of life and reduce secondary complications 4
- Venoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disorders 4
- Compression stockings can be used as a first-line treatment for varicose veins in people without healed or active venous ulceration, but the evidence is insufficient to determine their effectiveness or the optimum length and pressure of the stockings 5, 6
Symptoms and Complications
- Varicose veins can produce symptoms of pain, swelling, heaviness, fatigue, and pruritus, and can predispose patients to complications including bleeding, superficial thrombophlebitis, and ulcerations 3
- The use of compression stockings can help reduce symptoms and improve quality of life, but the evidence is limited by the low quality of the studies and the lack of standardization in the outcomes measured 5, 6