What is the treatment for an enlarged varicose vein without thrombosis (blood clot)?

From the Guidelines

Treatment for enlarged varicose veins without clotting typically begins with conservative measures, but the most effective approach is often endovenous thermal ablation, which can be performed under local anesthesia and has better outcomes and fewer complications than other treatments. According to the most recent and highest quality study 1, the recommended treatment options for varicose veins include compression therapy, saphenous vein ablation, compression sclerotherapy, or microphlebectomy. Some key points to consider in the treatment of varicose veins include:

• Conservative measures such as regular exercise, leg elevation, and compression stockings (20-30 mmHg pressure) worn daily from morning to evening
• Weight loss for overweight patients to reduce pressure on veins
• Over-the-counter pain medications like ibuprofen (400-600 mg every 6-8 hours) or acetaminophen (500-1000 mg every 6 hours) for symptom relief
• Medical interventions such as sclerotherapy, endovenous laser treatment, radiofrequency ablation, or surgical options like vein stripping or phlebectomy for patients who do not respond to conservative management
• The importance of continuing to wear compression stockings after any procedure to promote healing and prevent recurrence
• Avoiding prolonged standing or sitting, elevating legs when possible, and maintaining regular physical activity to improve circulation and prevent worsening of varicose veins. It's worth noting that the 2023 study 1 provides the most up-to-date and comprehensive guidelines for the treatment of varicose veins, and its recommendations should be prioritized in clinical practice.

From the Research

Treatment Options for Enlarged Varicose Veins without Thrombosis

• Various treatment options are available for enlarged varicose veins without thrombosis, including endovascular, surgical, and herbal treatments 2, 3, 4
• Conservative treatment with compression bandages is an option for all forms of varicosis and the accompanying complications 3
• Sclerotherapy of varices can specifically ablate veins, and mini-phlebectomy and subfascial endoscopic perforator surgery (SEPS) can also be performed 3
• Radiofrequency ablation (RFO) and endovenous laser therapy (ELT) are available as endovenous therapy options, showing significant improvement in quality of life and the venous clinical severity score (VCSS) 3, 4
• Echo-sclerosis hemodynamic conservative (ESEC) technique is a new treatment that combines ultrasound-monitored sclerosis, innovative sclerotherapy findings, and hemodynamic principles 5
• The choice of treatment depends on the type of varicose vein, with no single treatment universally employed 4
• Ligation with stripping plus phlebectomy is generally regarded as the "gold standard" for treating primary long saphenous veins 4
• Sclerotherapy and surgery both appear to have a place in the management of varicose veins, with sclerotherapy and phlebectomy suitable for patients with minor superficial varicose veins not related to reflux of the saphenous system 4
• Current evidence suggests endovenous laser therapy and radiofrequency ablation are as safe and effective as surgery, particularly in the treatment of saphenous veins 4

Factors to Consider

• The mechanisms, prevention, risk factors, complications, and treatment of varicose veins should be taken into account when choosing a treatment option 2
• Prolonged standing and obesity are major reasons for varicose vein disease, and preventive measures such as regular yoga/exercise and consumption of certain fruits and vegetables may help reduce the risk of varicose veins 2
• 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 2