What is the standard therapy for treating visible and varicose (enlarged) veins on the legs?

From the Guidelines

The standard therapy for treating visible and varicose veins on the legs includes conservative measures such as compression stockings (20-30 mmHg or 30-40 mmHg gradient compression) and medical interventions like sclerotherapy, endovenous thermal ablation, and surgery.

Conservative Measures

• Compression stockings should be worn daily from morning to evening to provide relief from discomfort and reduce venous stasis 1.
• Regular exercise to improve circulation, leg elevation when resting, and weight management if needed are also recommended 1.

Medical Interventions

• Sclerotherapy is commonly used for spider veins and small varicose veins, involving injection of a solution (such as polidocanol or sodium tetradecyl sulfate) that causes the vein to collapse and fade 1.
• Endovenous thermal ablation techniques like laser therapy (EVLT) or radiofrequency ablation (RFA) are effective for larger varicose veins, using heat to seal affected veins 1.
• Traditional vein stripping surgery is less common now but may be necessary for very large varicose veins 1.

Treatment Choice

Treatment choice depends on the size and location of veins, symptom severity, and patient preferences, with many procedures being performed on an outpatient basis with minimal recovery time 1.

Key Considerations

• The use of compression therapy has been widely described as a helpful initial treatment for varicose veins, with a minimum pressure of 20 to 30 mm Hg recommended 1.
• Adherence to compression therapy should be encouraged with proper fitting, education, and detailed instructions 1.
• The presence or absence of deep venous insufficiency and the characteristics of the affected veins can also help guide treatment 1.

From the Research

Standard Therapy for Treating Visible and Varicose Veins

The standard therapy for treating visible and varicose veins on the legs includes:

• Endovenous thermal ablation for truncal vein incompetence 2
• Thermal ablation using the transluminal occlusion of perforator (TRLOP) approach for significant incompetent perforating veins 2
• Coil embolisation for incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg 2
• Phlebectomy for bulging varicosities at the time of truncal vein ablation 2
• Sclerotherapy for small varicose veins or telangiectasia without symptoms or signs, for cosmetic reasons 2, 3
• Compression stockings or venotropic drugs as conservative treatment options 3

Treatment Options

Treatment options for varicose veins also include:

• External laser treatment 3
• Injection sclerotherapy 3, 4
• Endovenous interventions 3, 5
• Surgery 3, 5
• Radiofrequency ablation 6
• Foam sclerotherapy 6

Investigation and Diagnosis

Investigation and diagnosis of varicose veins include:

• Venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography 2
• Transvaginal duplex ultrasound (TVS) for pelvic vein reflux 2
• Venography or cross-sectional imaging for men or women unable to have TVS 2