Not all people with varicose veins need treatment because the severity of symptoms can vary greatly and in some cases it does not cause any pain at all.
However, some patients will need treatment for a variety of reasons; these may include relieving symptoms, treating complications of the condition or to improve the appearance of the veins.
The initial management plan involves simple steps that can be taken by the individual to improve their condition and symptoms.
Making an effort to move frequently throughout the day and keep the blood moving in the circulation is important. Likewise, patients should avoid sitting or standing for long periods of time. For quick relief of the heaviness and discomfort in the legs, raising the area when resting may be beneficial.
Compression stockings are designed specifically to apply pressure around the legs and improve the circulation of blood. They are usually tightest at the bottom around the ankle, which helps the blood to flow up towards the heart. Studies have shown that they help to relieve symptoms of varicose veins such as pain and swelling, although it is not known if they help to prevent the development of varicose veins.
Radiofrequency ablation is performed under local anesthetic and involves an incision being made near the knee, allowing for the entrance of a catheter into the area. An ultrasound scan helps to guide its placement and a probe can be inserted into the catheter to direct radio waves towards the vein walls until they collapse. When the vein has been sealed, the blood will naturally redirect to another healthy vein.
This procedure is generally well tolerated but may cause some immediate adverse effects, such as paresthesia in the area. It is usually recommended to wear compression stockings for up to 7 days following treatment.
Endovenous Laser Treatment
Endovenous laser treatment also uses an ultrasound scan to guide the insertion of the catheter into the vein in the legs. When positioned correctly, laser energy is exerted in short bursts to heat the vein wall until it collapses and seals shut. The catheter can be drawn along the vein to apply the laser energy along the length and close the entire vein.
Similarly to the treatment with radio waves, this procedure is also carried out under local anaesthetic. After the treatment, adverse effects of tightness, bruising and pain in the area may be noted, although they are usually short lived.
This is an alternative treatment that involves injections of foam into the veins, which forms scar tissue and causes them to collapse. An ultrasound scan is utilized to view the area that is being treated and, in this way, several veins can be targeted in one treatment session.
The efficacy of sclerotherapy is statistically significant for immediate benefits with 84 out of 100 patients noting improvements on average, although the long-term effects are unclear.
It is worth noting that sclerotherapy is not the treatment of choice if the patient has a medical history of deep vein thrombosis. This is due to the increased risk of blood clots in other veins in the legs associated with this therapy.
Litigation and Stripping
If other treatments have failed, surgery to improve varicose veins may be indicated. Litigation and stripping is a procedure that is usually carried out under general anesthetic and involves the surgical closure and removal of affected veins.
Two small incisions are made at each end of the vein, commonly near the groin and at the knee or ankle. The superior end of the vein is then tied and sealed shut and a fine wire is threaded through the vein. This does not affect the blood flow, but may cause pain, bruising and bleeding in some patients. Recovery time is highly variable depending on the health of the individual and may take up to a month.