From the Guidelines
Treatment for enlarged varicose veins without thrombosis typically begins with conservative measures, but recent evidence suggests that endovenous thermal ablation may be considered as a first-line treatment due to its effectiveness and minimal complications. According to the American Family Physician 1, varicose veins are twisted, dilated veins that can cause symptoms such as a heavy, achy feeling and an itching or burning sensation. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure.
Conservative Treatment Options
Conservative treatment options include:
- External compression
- Lifestyle modifications, such as avoidance of prolonged standing and straining, exercise, wearing nonrestrictive clothing, modification of cardiovascular risk factors, and interventions to reduce peripheral edema
- Elevation of the affected leg
- Weight loss
- Medical therapy However, there is not enough evidence to determine if compression stockings are effective in the treatment of varicose veins in the absence of active or healed venous ulcers 1.
Interventional Treatments
Interventional treatments include:
- External laser thermal ablation
- Endovenous thermal ablation
- Endovenous sclerotherapy
- Surgery Although surgery was once the standard of care, it largely has been replaced by endovenous thermal ablation, which can be performed under local anesthesia and may have better outcomes and fewer complications than other treatments 1.
Recommendation
Endovenous thermal ablation is a recommended treatment option for enlarged varicose veins without thrombosis, as it has been shown to be effective and have minimal complications. A trial of compression therapy is not warranted before referral for endovenous thermal ablation, although it may be necessary for insurance coverage 1. Weight loss is also recommended for overweight patients, as excess weight increases venous pressure 1. Avoid prolonged standing or sitting, and take breaks to walk around every 30-60 minutes when stationary. For symptom relief, over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort.
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
- Endovascular treatments, such as radiofrequency ablation (RFA) and endovenous laser ablation (EVLA), are minimally invasive and can be effective in treating varicose veins 3, 4
- Surgical treatments, such as superficial vein ligation, phlebectomy, and stripping, have been the mainstay of treatment for varicose veins, but may have higher morbidity compared to endovascular treatments 5, 4
- Herbal treatments, such as flavonoids and saponins, may have a therapeutic effect on chronic venous disorders and can be used as an adjunct to other treatments 2
- Foam sclerotherapy can also be used as an adjunct to RFA to treat residual varicosities 3
Considerations for Treatment
- The choice of treatment depends on the severity of the varicose veins, the presence of symptoms, and the patient's overall health 2, 4
- Imaging techniques, such as colour duplex ultrasonography, are crucial in assessing the superficial and deep venous system to enable assessment of venous competence and plan treatment 4
- Patients with bleeding varicose veins or suspected venous incompetence should be referred to a vascular service immediately 4