From the Guidelines
Endovenous ablation, specifically radiofrequency ablation (RFA) or endovenous laser ablation (EVLA), is the recommended treatment for enlarged varicose veins due to its high efficacy, improved quality of life, and reduced hospital recovery time compared to surgical ligation and stripping 1.
Treatment Options
The treatment options for varicose veins can be categorized into conservative and interventional approaches. Conservative measures include:
- Regular exercise
- Leg elevation
- Avoiding prolonged standing
- Wearing compression stockings (20-30 mmHg or 30-40 mmHg for more severe cases)
- Maintaining a healthy weight These methods help improve blood flow and reduce symptoms like pain, swelling, and discomfort.
Interventional Approaches
For more significant varicose veins, medical procedures may be necessary. These include:
- Sclerotherapy (injection of a solution to collapse the vein)
- Endovenous laser treatment or radiofrequency ablation (using heat to close the vein)
- Ambulatory phlebectomy (removal through small incisions)
- Vein stripping (surgical removal) Most procedures are outpatient with minimal recovery time. After treatment, patients should continue wearing compression stockings for 1-2 weeks, stay active with walking, and avoid heavy lifting for about a week.
Recent Developments
Recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery 1. When compared to surgery, EVLA had fewer rates of bleeding, hematoma, and wound infection 1. EVLA and RFA were also noted to have reduced rates of paresthesia compared to surgery 1.
Quality of Life
Current data on RFA versus EVLA is rather limited, although there have been some recent developments. Studies have shown that both EVLA and RFA have similar safety and efficacy, with no statistically significant difference in long-term outcomes between the two treatment cohorts 1. The choice of treatment should be based on symptoms, patient preferences, and the presence or absence of deep venous insufficiency, as well as the characteristics of the affected veins 1.
From the FDA Drug Label
For extensive varicosities, longer compression treatment with compression bandages or a gradient compression stocking of a higher compression class is recommended. Repeat treatments may be necessary if the extent of the varicose veins requires more than 10 mL. Small intravaricose thrombi that develop may be removed by microthrombectomy.
The treatment options for an enlarged varicose vein (varicosity) include:
- Compression treatment with compression bandages or a gradient compression stocking of a higher compression class for extensive varicosities
- Repeat treatments with polidocanol injection, separated by 1 to 2 weeks, if the extent of the varicose veins requires more than 10 mL
- Microthrombectomy to remove small intravaricose thrombi that develop 2
From the Research
Treatment Options for Varicose Veins
The treatment options for varicose veins include:
- Endovenous radiofrequency obliteration (RFO) 3
- Endovenous laser therapy (EVLT) 3
- Foam sclerotherapy (FS) 3, 4, 5
- Surgical treatments such as ligation and vein stripping 3
- Herbal treatments 6
- Echo-sclerosis hemodynamic conservative (ESEC) technique 7
- Phlebectomy and perforator ligation 5
Characteristics of Treatment Options
- RFO is associated with the worst short and long-term safety and efficacy results compared to EVLT and FS 3
- EVLT has the best results concerning long-term effectiveness parameters for occlusion at the end of follow-up and recanalization, recurrence or development of new veins 3
- Foam sclerotherapy is associated with a higher recurrence rate in patients with saphenofemoral incompetence compared to EVLT or RFO treatment 3
- Sclerotherapy using a new sclerosing foam made of purified sodium tetradecylsulfate is a promising technique for larger veins 4
- Adjunct foam sclerotherapy with Radio Frequency Ablation (RFA) has a complication rate of roughly one tenth and one fifth of the treated cases in immediate and early postoperative follow-up 5
Considerations for Treatment
- The choice of treatment should be based on the individual patient's condition and medical history 3, 6
- Patients with varicose veins should consider taking antioxidant medicament from the flavonoid groups to reduce arterial blood pressure value, risk of atherosclerosis development, and prevent thrombotic incidents 6
- Venoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disorders 6
- Food rich in phytoconstituents may be effective in varicose veins 6