From the Guidelines
Swollen and painful leg veins should be treated with compression therapy, sclerotherapy, or endovenous ablation, as these methods have been shown to improve symptoms and quality of life, according to the most recent and highest quality study 1.
Initial Assessment
The initial assessment of swollen and painful leg veins should include a thorough physical examination, medical history review, and diagnostic tests such as duplex ultrasound, which is the gold standard for evaluating venous conditions 1.
Treatment Options
Treatment options for swollen and painful leg veins include:
- Conservative measures such as compression therapy (20-30 mmHg graduated compression stockings worn daily), leg elevation above heart level for 30 minutes several times daily, regular exercise like walking, and avoiding prolonged standing or sitting 1
- Sclerotherapy (injection of a solution to collapse affected veins) 1
- Endovenous laser or radiofrequency ablation to seal problematic veins 1
- Surgical procedures like phlebectomy for vein removal 1
Medications
Over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help manage discomfort 1.
Anticoagulation Therapy
Anticoagulation therapy with medications like enoxaparin (1mg/kg twice daily) or rivaroxaban (15mg twice daily for 21 days, then 20mg daily) is essential if deep vein thrombosis (DVT) is diagnosed 1.
Importance of Prompt Treatment
Prompt treatment is important as chronic venous insufficiency can lead to complications like skin changes, ulceration, and decreased quality of life 1.
From the Research
Assessment Modalities for Swollen and Painful Leg Veins
- The assessment of swollen and painful leg veins typically involves a multifaceted approach, including clinical assessment, evaluation of pre-test probability, and objective diagnostic testing 2.
- Compression ultrasound (CUS) is a key diagnostic tool for deep vein thrombosis (DVT), with high sensitivity and specificity, and is non-invasive, readily available, and avoids radiation exposure 3.
- The Wells score is a clinical decision rule that can be used to assess the pre-test probability of DVT, and can be modified to improve diagnostic accuracy 4.
- D-dimer testing can be used to exclude DVT, and has a high negative predictive value 4.
Treatment Modalities for Swollen and Painful Leg Veins
- Anticoagulation is the primary treatment for DVT, and can consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) 2.
- DOACs are the preferred treatment for DVT, as they are at least as effective, safer, and more convenient than warfarin 2.
- Compression therapy, such as wearing medical elastic stockings, can be used to prevent post-thrombotic syndrome (PTS) and reduce the risk of DVT recurrence 4.
- Low-molecular-weight heparin (LMWH) can be used for thromboprophylaxis after varicose vein surgery in moderate-risk patients, but its use is not universally recommended 5.
Risk Stratification and Prognosis
- Risk stratification is important for identifying patients at high risk of recurrent thrombosis and/or post-thrombotic syndrome, and can be done using DUS and D-dimer testing 4.
- The risk of pulmonary embolism is a significant concern in patients with DVT, and can be reduced with anticoagulation therapy 2, 6.
- Post-thrombotic syndrome is a common complication of DVT, and can be prevented or reduced with compression therapy and anticoagulation 4.