From the Guidelines
Treatment for enlarged varicose veins should prioritize endovenous thermal ablation as the first-line interventional approach, as it has been shown to have better outcomes and fewer complications compared to other treatments, including surgery. This is based on the most recent and highest quality study available, which was published in 2023 in the Journal of the American College of Radiology 1.
Conservative Measures
Conservative measures, such as regular exercise, elevating the legs, avoiding prolonged standing or sitting, wearing compression stockings (20-30 mmHg pressure), and maintaining a healthy weight, can help improve blood flow and reduce symptoms like pain, swelling, and discomfort. However, the evidence for the effectiveness of compression stockings alone is lacking, and they should not be relied upon as the sole treatment for varicose veins 1.
Interventional Approaches
For more severe cases, medical interventions may be necessary. These include:
- Endovenous laser treatment or radiofrequency ablation (using heat to seal veins)
- Sclerotherapy (injection of a solution to close the vein)
- Ambulatory phlebectomy (removal through tiny incisions)
- Vein stripping (surgical removal)
Treatment Choice
The choice of treatment depends on the size and location of varicose veins, symptoms, and overall health. Varicose veins develop when valves in the veins weaken, allowing blood to pool instead of flowing efficiently back to the heart. Treatment aims to redirect blood flow through healthier veins, improving circulation and reducing symptoms. Patients should consult a vascular specialist to determine the most appropriate treatment option for their specific condition.
Key Considerations
- Endovenous thermal ablation is a minimally invasive procedure that can be performed under local anesthesia and has been shown to have better outcomes and fewer complications compared to surgery 1.
- Compression therapy, including the use of compression stockings, can be effective in reducing symptoms and improving circulation, but its effectiveness as a standalone treatment is limited 1.
- Lifestyle modifications, such as regular exercise and weight loss, can also help improve symptoms and reduce the risk of further complications 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. Asclera has not been studied in varicose veins more than 3mm in diameter. The treatment for an enlarged varicose vein is sclerotherapy with polidocanol for veins ≤3 mm in diameter.
- For varicose veins ≤1 mm in diameter, use Asclera 0.5%.
- For varicose veins 1 to 3 mm in diameter, use Asclera 1%.
- Compression treatment is necessary after treatment to reduce the risk of deep vein thrombosis.
- Repeat treatments may be necessary if the extent of the varicose veins requires more than 10 mL, separated by 1 to 2 weeks 2. Note that Asclera has not been studied in varicose veins more than 3mm in diameter 2.
From the Research
Treatment Options for Enlarged Varicose Veins
The treatment for enlarged varicose veins includes several options, such as:
- Endovenous radiofrequency obliteration (RFO)
- Endovenous laser therapy (EVLT)
- Foam sclerotherapy (FS)
- Surgical treatments like ligation and vein stripping
- Endovascular treatments
- Herbal treatments
Effectiveness and Safety of Treatment Options
Studies have shown that:
- EVLT had the best results concerning the long-term effectiveness parameters for ''occlusion at the end of follow-up'' and ''recanalization, recurrence or development of new veins'', compared to RFO and FS 3
- Foam sclerotherapy of varicose veins is associated with a higher recurrence rate in patients with saphenofemoral incompetence compared to the rates after EVLT or RFO treatment 3
- RFO was associated with the worst short and long-term safety and efficacy results compared to EVLT and FS regarding ''complete occlusion at the end of follow-up'', ''phlebitis'', ''deep vein thrombosis'', and ''paraesthesia'' 3
- Sclerotherapy using a new sclerosing foam (Tessari's method) showed promising results, especially for larger veins, with no serious complications reported 4
- Adjunct foam sclerotherapy with Radio Frequency Ablation (RFA) showed a complication rate of roughly one tenth and one fifth of the treated cases in immediate and early postoperative follow-up 5
Other Considerations
Other factors to consider in the treatment of varicose veins include:
- Prevention measures such as regular yoga/exercise and consumption of fruits and vegetables like Grapes, blackberries, avocados, ginger, and rosemary 6
- The use of venoactive drugs such as flavonoids, saponins, and others, which have a therapeutic effect on chronic venous disorders 6
- The importance of further research to validate new techniques and compare their effectiveness and safety with existing treatments 3, 4, 5, 7