From the Guidelines
Treatments for varicose veins in the lower extremities should prioritize endovenous thermal ablation, such as endovenous laser treatment (EVLT) or radiofrequency ablation, as the first-line interventional treatment option, due to its effectiveness, minimal recovery time, and fewer complications compared to surgical interventions 1.
Conservative Measures
For mild cases, self-care measures include:
- Regular exercise
- Elevating legs when resting
- Avoiding prolonged standing or sitting
- Wearing compression stockings (20-30 mmHg pressure) daily, although evidence for its effectiveness is lacking 1
- Weight loss for overweight individuals
- 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 1
Medical Interventions
If conservative measures fail, several medical interventions are available:
- Sclerotherapy, which involves injecting a solution directly into the vein, causing it to collapse and fade over time; multiple sessions may be needed 1
- Endovenous laser treatment (EVLT) or radiofrequency ablation, which uses heat to seal affected veins and typically takes 30-60 minutes with minimal recovery time 1
- Ambulatory phlebectomy, which involves removing veins through tiny skin incisions under local anesthesia, for larger varicose veins 1
- Traditional vein stripping surgery, which is less common now but may be necessary for extensive cases 1
Considerations
The decision to proceed with treatment and the choice of treatment should be based on symptoms, patient preferences, cost, potential for complications, availability of resources, insurance reimbursement, and physician training 1. The presence or absence of deep venous insufficiency and the characteristics of the affected veins can also help guide treatment 1.
From the Research
Treatment Options for Varicose Veins
- Conservative treatment options include medications, compression stockings, and lifestyle changes 2, 3
- Minimally invasive treatment options include sclerotherapy, endoluminal ablation, endovenous laser therapy, and radiofrequency ablation 2, 4, 5
- Invasive treatment options include surgical techniques such as high ligation and stripping, mini-phlebectomy, and subfascial endoscopic perforator surgery (SEPS) 4
- Hybrid treatment options involve a combination of two or more therapies 2
Conservative Therapy
- Compression therapy with compression bandages and compression stockings is a key component of conservative therapy 3, 6
- Medical adaptive compression systems can also be used in the decongestion phase 3
- Oral drug therapy options include extract from red vine leafs, extract from horse chestnut seed, and oxerutin 3
Post-Treatment Compression
- Compression treatments can range from no compression to elastic stockings and compression bandaging 6
- There is no consensus on the strength or duration of compression that should be applied following treatment 6
- Higher levels of compression are more effective than lower levels in moderating postoperative pain and complications 6
Effectiveness of Treatment Options
- Minimally invasive therapies such as endovenous laser therapy, radiofrequency ablation, and foam sclerotherapy are as safe and effective as conventional surgery 5
- There is low to moderate evidence that minimally invasive treatments are comparable to conventional surgery regarding effectiveness and safety for treatment of varicose veins 5