From the Guidelines
Varicose vein dots, also known as spider angiomas or telangiectasias, are best managed with compression therapy, providing 20-30 mmHg of pressure, as the initial treatment approach. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of compression therapy in reducing venous stasis and improving symptoms 1.
Treatment Options
- Compression therapy: providing 20-30 mmHg of pressure to improve blood flow and reduce symptoms, with pressures of 30-40 mmHg advised for more severe disease 1
- Elevating legs above heart level for 15-20 minutes several times daily to reduce pressure and swelling
- 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
- Weight loss, which may improve symptoms in patients who are obese 1
- Phlebotonics, such as horse chestnut seed extract, which may provide symptomatic relief, although long-term studies are lacking 1
Interventional Treatments
- Sclerotherapy: an effective medical procedure where a solution is injected to collapse the visible vessels
- Laser therapy: uses targeted light energy to seal off small vessels
- Endovenous thermal ablation: a minimally invasive procedure that can be performed under local anesthesia and may have better outcomes and fewer complications than other treatments 1
- Surgery: although historically the standard of care, it is now largely replaced by endovenous thermal ablation, and is recommended as third-line therapy after endovenous thermal ablation and sclerotherapy 1
Prevention
- Maintaining a healthy weight
- Regular exercise, such as walking 30 minutes daily
- Avoiding prolonged standing
- Wearing nonrestrictive clothing
- Modifying cardiovascular risk factors
- Interventions to reduce peripheral edema 1
From the Research
Varicose Vein Treatment Options
- Varicose veins are twisted, dilated veins most commonly located on the lower extremities, with risk factors including chronic cough, constipation, family history of venous disease, female sex, obesity, older age, pregnancy, and prolonged standing 2.
- The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure 2.
- Symptoms of varicose veins include a heavy, achy feeling, itching or burning, and worsening with prolonged standing 2.
Conservative and Minimally Invasive Treatment Options
- Conservative treatment options include avoidance of prolonged standing and straining, elevation of the affected leg, exercise, external compression, loosening of restrictive clothing, medical therapy, modification of cardiovascular risk factors, reduction of peripheral edema, and weight loss 2.
- Minimally invasive therapies, such as endovenous laser therapy, radiofrequency ablation, and foam sclerotherapy, are as safe and effective as conventional surgery (ligation and stripping) 3.
- There is low to moderate evidence that minimally invasive treatments are comparable to conventional surgery regarding effectiveness and safety for the treatment of varicose veins 3, 4.
Surgical Treatment Options
- Conventional surgery, such as ligation and stripping, is a traditional treatment option for varicose veins 4.
- Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are minimally invasive surgical options that have been shown to be effective in treating varicose veins 4, 5.
- Ultrasound-guided foam sclerotherapy (UGFS) is another minimally invasive option, but the quality of evidence is low, and its effectiveness compared to conventional surgery is uncertain 4.
Prevention and Lifestyle Changes
- Prolonged standing and obesity are major risk factors for varicose vein disease, and lifestyle changes such as regular exercise, weight loss, and elevation of the affected leg can help prevent or alleviate symptoms 6.
- Consuming foods rich in phytoconstituents, such as grapes, blackberries, avocados, ginger, and rosemary, may also help improve quality of life and reduce secondary complications of varicose veins 6.