From the Guidelines
Varicose veins should be treated with endovenous thermal ablation as the first line of treatment for symptomatic patients, as it has been shown to have better outcomes and fewer complications compared to other treatments, including surgery 1.
Treatment Options
The treatment of varicose veins depends on the severity of the symptoms and the patient's preferences. Conservative measures, such as:
- Regular exercise
- Elevating legs when resting
- Avoiding prolonged standing or sitting
- Maintaining a healthy weight
- Wearing compression stockings (20-30 mmHg pressure) can be effective for mild cases. However, for more severe cases, medical procedures such as:
- Sclerotherapy (injection of a solution to close the vein)
- Laser treatment
- Radiofrequency ablation
- Surgical removal may be necessary.
Diagnosis and Pathophysiology
Varicose veins are twisted, dilated veins most commonly located on the lower extremities, and are caused by a combination of genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure 1. Risk factors include family history of venous disease, female sex, older age, chronically increased intra-abdominal pressure, and prolonged standing.
Complications and Morbidity
Varicose veins can lead to complications such as infection, leg ulcers, stasis changes, and thrombosis, which can significantly impact the patient's quality of life 1. Therefore, seeking medical attention is important if varicose veins become painful, lead to skin changes, or if you develop sudden leg swelling, as these may indicate complications requiring immediate treatment.
Current Recommendations
The current recommendations for the treatment of varicose veins have shifted towards minimally invasive endovascular techniques, such as endovenous thermal ablation, due to their effectiveness and lower risk of complications compared to surgery 1. Compression stockings are no longer recommended as the first line of treatment, except in pregnant women or as required by insurance companies before approval of interventional treatments.
From the Research
Causes and Risk Factors of Varicose Veins
- Prolonged standing and obesity are major reasons for varicose vein disease 2
- Varicose veins can be caused by damages to blood vessels, leading to painful swelling and blood clots 2
Symptoms of Varicose Veins
- Varicose veins can cause discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis, and venous bleeds 3
- Symptoms can subjectively improve with the wearing of compression stockings 4, 5
Treatment of Varicose Veins
- Compression stockings are often the first line of treatment for varicose veins in people without either healed or active venous ulceration 4, 5
- Endovascular, surgical, and herbal treatments can improve quality of life and reduce secondary complications of varicose veins 2, 3
- Best practice for treating truncal vein incompetence is endovenous thermal ablation 3
- Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation 3
Prevention of Varicose Veins
- Varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary 2
- Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents 2
Compression Stockings
- Low compression stockings can provide adequate support for the leg after varicose vein surgery 6
- High compression stockings can produce comparable results to Elastocrepe bandages with stockings after sclerotherapy 6
- The optimum length or pressure of compression stockings is still unclear, and further research is needed 4, 5