From the Guidelines
Treatment for enlarged varicose veins should prioritize endovenous laser ablation as the first-line invasive option, as it has been shown to have favorable 5-year results compared to conventional surgery and ultrasound-guided foam sclerotherapy 1. When considering treatment options, it's essential to evaluate the severity of the varicosity and the patient's overall health. Conservative approaches can be effective for mild cases and include:
- Wearing compression stockings (20-30 mmHg pressure)
- Elevating legs regularly
- Avoiding prolonged standing
- Exercising to improve circulation
- Maintaining a healthy weight For more severe cases, medical procedures are recommended, including:
- Sclerotherapy (injection of a solution to collapse the vein)
- Endovenous laser treatment (EVLT) or radiofrequency ablation (RFA) which use heat to close off problematic veins
- Ambulatory phlebectomy (removal of veins through tiny incisions)
- Traditional vein stripping surgery for very large varicose veins These treatments work by either removing the damaged veins or redirecting blood flow to healthier veins. According to the most recent guidelines, endovenous laser ablation has been found to be a highly effective treatment option, with a study published in the Journal of the American College of Radiology in 2023 supporting its use 1. The goal of treatment is to alleviate symptoms, improve quality of life, and prevent complications, such as ulcers, bleeding, or thrombophlebitis. Most procedures are outpatient with minimal recovery time, though compression stockings are usually required for 1-2 weeks afterward to promote healing and reduce complications. Pain medications like ibuprofen can manage any discomfort following procedures.
From the Research
Treatment Options for Varicose Veins
The treatment of varicose veins aims to eliminate congestive symptoms and edema, heal skin complications, and prevent complications 2. The available treatment options include:
- Surgical procedures
- Endovenous thermal procedures
- Endovenous chemical procedures
- Conservative measures
Conservative Treatment
Conservative therapy focuses on compression therapy with compression bandages and compression stockings 2. Medical adaptive compression systems are also used in the decongestion phase. Additionally, oral drug therapy options include:
- Extract from red vine leafs
- Extract from horse chestnut seed
- Oxerutin
Conservative therapy is especially indicated when treatment of symptomatic varicose veins is not possible or when symptomatic venous disease persists even after invasive therapy 2.
Minimally Invasive Procedures
Minimally invasive endovascular techniques have become popular in recent years, including:
- Endovenous laser ablation (EVLA)
- Radiofrequency ablation (RFA)
- Endovenous foam sclerotherapy
- Mechanochemical endovenous ablation (MOCA)
- Cyanoacrylate embolization
These procedures 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, 4.
Surgical Procedures
Surgical procedures, including saphenous vein stripping, ligation of the saphenofemoral junction, and ambulatory phlebectomy, are effective in the treatment of varicose veins but are associated with a high complication rate and recovery time 4, 5.
Best Practice in Management
The current best practice in the management of varicose veins involves:
- Investigation with venous duplex ultrasound in the erect position
- Treatment of truncal vein incompetence with endovenous thermal ablation
- Treatment of significant incompetent perforating veins with thermal ablation using the transluminal occlusion of perforator (TRLOP) approach
- Treatment of incompetent pelvic veins refluxing into symptomatic varicose veins with coil embolisation
- Phlebectomy for bulging varicosities at the time of truncal vein ablation 6.