From the Guidelines
Varicose vein treatment should prioritize conservative measures, including avoidance of prolonged standing and straining, exercise, wearing nonrestrictive clothing, modification of cardiovascular risk factors, and interventions to reduce peripheral edema, as well as elevation of the affected leg, weight loss, and phlebotonics, before considering endovenous or surgical management. When considering compression therapy, it is essential to note that while compression has long been recommended as initial therapy for varicose veins, there is not enough evidence to determine its effectiveness in the absence of active or healed venous ulcers 1. The use of compression stockings, typically 20 to 30 mm Hg elastic compression stockings with a gradient of decreasing pressure from the distal to proximal extremity, may be recommended in certain cases, such as when required by insurance companies before approval of interventional treatments or as first-line therapy in pregnant women 1. Key aspects of varicose vein management include:
- Avoidance of prolonged standing and straining
- Regular exercise
- Wearing nonrestrictive clothing
- Modification of cardiovascular risk factors
- Interventions to reduce peripheral edema
- Elevation of the affected leg
- Weight loss
- Phlebotonics It is crucial to approach varicose vein treatment with a focus on the individual patient's needs and circumstances, considering the potential benefits and limitations of each treatment option, as outlined in the 2019 study on varicose veins diagnosis and treatment 1.
From the Research
Varicose Vein DVT
- Varicose veins (VVs) can lead to serious complications, including deep venous thrombosis (DVT) and pulmonary embolism (PE) 2.
- The risk of DVT is increased in patients with VVs, particularly those with previous venous thromboembolism (VTE), malignancy, estrogen use, pregnancy and postpartum, hospitalization in the last 6 months, age, and obesity 2.
- Superficial venous thrombosis is related to an increased risk for DVT, particularly if the thrombus in the superficial vein extends close to the saphenofemoral or femoropopliteal junction 2.
- Increased risk for DVT is also increased during and after invasive treatment of VVs, and thromboprophylaxis after invasive procedures is recommended in subjects older than 60 years and those with another thrombophilic state 2.
Prevention and Treatment
- The best way to prevent DVT is to prevent varicose veins with pharmacologic or mechanical thromboprophylaxis used in high-risk patients and settings 3.
- In patients with established post-thrombotic syndrome (PTS), prescribing 20-30 mm Hg knee-length elastic compression stockings (ECS) to be worn daily is suggested 3.
- A supervised exercise training program for 6 months or more is reasonable for PTS patients who can tolerate it 3.
- Management of post-thrombotic ulcers should involve a multidisciplinary approach 3.
Risk Factors and Complications
- Prolonged standing and obesity are major reasons for varicose vein disease 4.
- Varicose veins can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary 4.
- 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 4.
Thromboprophylaxis
- The use of low-molecular-weight heparin (LMWH) for prevention of venous thromboembolism after varicose vein surgery in moderate-risk patients has been studied, but no significant differences were seen between groups in the rates of bleeding episodes 5.
- A systematic review and meta-analysis found that the rate of DVT after endovenous procedures for varicose veins is higher than other day-case procedures and could be reduced with pharmacological thromboprophylaxis 6.
- The review suggested that routine prescription of anticoagulation after endovenous varicose vein intervention should be considered, but risk stratification in future randomized interventional studies is critical to establish the clinical effectiveness and safety of additional pharmacological thromboprophylaxis 6.