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.
Conservative Measures
Before considering interventional procedures, conservative measures can be taken to alleviate symptoms, including:
- Regular exercise
- Leg elevation
- Wearing compression stockings (20-30 mmHg pressure)
- Maintaining a healthy weight
- Avoiding prolonged standing or sitting
- Weight loss, if obese, to improve symptoms 1
- Phlebotonics, such as horse chestnut seed extract, may provide symptomatic relief, although long-term studies are lacking 1
Interventional Procedures
When conservative measures are insufficient, the following interventional procedures can be considered:
- Sclerotherapy (injection of a solution to collapse the vein)
- Endovenous laser treatment or radiofrequency ablation (using heat to close veins)
- Vein stripping (surgical removal)
- Phlebectomy (removal through small incisions)
- Thermal ablation, including external laser thermal ablation and endovenous thermal ablation (using a laser or radio waves) 1
- Endovenous sclerotherapy, using agents such as hypertonic saline, sodium tetradecyl, and polidocanol 1
Choice of Treatment
The choice of treatment depends on the size and location of varicose veins, symptom severity, and overall health. Most procedures are outpatient with minimal recovery time, though compression stockings are typically recommended for 1-2 weeks afterward to promote healing and reduce complications 1.
Recent Developments
Recent meta-analyses have confirmed 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. Additionally, EVLA and RFA have reduced rates of paresthesia compared to surgery 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:
- Sclerotherapy with polidocanol (IV) injection, with the volume and concentration depending on the size and extent of the varicose veins 2
- Compression treatment with compression bandages or a gradient compression stocking of a higher compression class for longer periods 2
- Repeat treatments if the extent of the varicose veins requires more than 10 mL of polidocanol (IV) injection, separated by 1 to 2 weeks 2
- 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