When it comes to varicose veins, the most effective treatment depends on the size or severity of the veins, and options range from self-care to surgery.
In some cases, a combination of treatments may work best. Treatment aims at reducing symptoms and preventing complications.
At-home measures are typically recommended as first-line treatment to minimize the severity of the symptoms and prevent them from worsening:
- Wearing compression stockings
- Elevating the legs
- Avoiding long periods of sitting or standing
- Exercising regularly
Laser treatment destroys varicose veins through a process called ablation. Depending on the type of veins involved, it is of two types.
- Simple laser therapy: Done for smaller veins closer to the skin
- Endovenous laser therapy (EVLT): Involves inserting a laser fiber into the veins, making them close up
Radiofrequency ablation (RFA)
This type of treatment destroys larger varicose by passing an electric current through a fiber inserted into the vein. After assessing your veins, your doctor may recommend either EVLT or RFA. Both procedures generate heat and cause the veins to collapse and close completely. They are often considered an alternative option for surgery.
Phlebectomy, also called stab avulsion or vein stripping, involves making several tiny cuts in the skin through which the varicose vein is removed. Your doctor may perform a phlebectomy immediately after ablation. However, phlebectomy has a longer recovery time as compared to ablation.
- Ligation and stripping: Involves surgically tying veins through a small incision in the skin to prevent blood from collecting. Ligation may be used in combination with vein stripping.
- Sclerotherapy: Involves injecting a chemical called sclerosant into a varicose vein to damage and scar the inside lining of the vein. This therapy causes the vein to close and works more effectively for small veins than for large veins.
This treatment involves using medications instead of heat to destroy varicose veins:
- The first one approved by the FDA is Laureth-9, which is a sclerosing agent. It works by increasing the formation of blood clots and scar tissue inside the veins, which helps decrease the dilation of enlarged veins.
- The second non-thermal ablation treatment for varicose veins is the VenaSeal system, which uses glue to shut off the vein.
What causes varicose veins?
Veins contain one-way valves that keep the blood flowing from the legs to the heart. When these valves become weak, blood is not able to flow toward the heart as efficiently as it should, so it gets collected in the vein. Over time, accumulated blood puts pressure on the walls of the veins, which causes the veins to dilate and become twisted.
Factors that increase the risk of developing varicose veins include:
What are symptoms of varicose veins?
Not all varicose veins cause symptoms. Some may just be a cosmetic concern, as they can appear dark purple or blue, twisted, or bulging. In some cases, they may be accompanied by:
- Muscle cramping
- Feeling of heaviness
- Pain after sitting or standing for a long time
- Skin discoloration
Spider veins are smaller versions of varicose veins and often look like a spider’s web.
What tests are done to diagnose varicose veins?
Diagnosis of varicose veins requires taking your medical history and performing a physical examination, symptoms analysis, and a Doppler ultrasound of the legs.
Doppler ultrasound is an imaging test that involves moving a small device called a transducer over the legs. The test lets your doctor know if there is a weakened vein valve and can show whether there is a blood clot in the veins.
What are the complications of varicose veins?
Complications of varicose veins are rare. If they occur, they may include:
- Varicose ulcers: You may develop painful ulcers, especially over the ankle. These ulcers can take time to heal and keep recurring even after being healed.
- Blood clots: Stagnated blood can clot and cause your leg to swell. The condition causes the veins to enlarge and become inflamed (thrombophlebitis).
- Bleeding: Varicose veins close to the skin can burst and cause bleeding.
If you develop any of these complications, seek medical attention immediately.
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Varicose Veins and Spider Veins. https://emedicine.medscape.com/article/1085530-overview
McHugh SM, Leahy AL. What next after thermal ablation for varicose veins: non-thermal ablation? Surgeon. 2014 Oct;12(5):237-8. https://pubmed.ncbi.nlm.nih.gov/25107833/
Bootun R, Lane TR, Davies AH. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology. 2016 Feb;31(1):5-14. https://pubmed.ncbi.nlm.nih.gov/26130051/
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