1. Compression Stockings
Compression stockings are elastic stockings that compress your veins to prevent blood from flowing backward – it basically augments the calf pump. The calf muscle are a very important and effective way blood is returned to the heart. For patients with mild to moderate symptoms, compression stockings may be all that is needed to relieve pain, swelling and prevent progression of varicose veins. Patients with severe varicose veins may need to wear compression stockings life long. It is important to note that compression stockings will not cure varicose veins so if a person stops wearing them, their symptoms will return and likely progress.
When this therapy fails to relieve a person’s symptoms, a surgical or minimally invasive treatment may be necessary. These treatments include sclerotherapy, endovenous laser ablation, vein stripping, hight ligation or surface laser treatment.
There are many medications which claim to be effective towards varicose veins but on a few have good research to support the claim. Aescin, also known as hose chestnut seed extract, has probably the most data proving that it is effective towards reducing pain, swelling, itching and leg circumference. Ibuprofen, and other NSAID's, are very effective treatment for pain related to varicose vein through its anti-inflammatory effect. Inflammation is a key component of varicose vein pain. Consult your vein specialist to determine whether you would be a good candidate for medical treatment.
Surgical or Procedural
During sclerotherapy, a chemical (agent) is injected into the varicose veins through a small needle. The chemical irritates and eventually scars the veins from the inside which ultimately destroys it. Blood from the leg now returns to the heart by alternative pathways through normal veins. Your body will eventually absorb the veins that received the injection. This modality is very effective on smaller veins, less than 3mm. This is also my preferred method for treating recurrent varicose veins. For larger veins or perforators, a foam suspension is more effective but even then, I recommend EVLT for this application whenever possible. Multiple treatment sessions is the norm when treating varicose veins exclusively this way. Our preferred agent is polidocanol which causes less pain and has resulted in fewer side effects such as hyperpigmentation compared to others.
2. Laser Treatment (EVLT)
Laser treatment is another effective method to treat varicose veins. The laser tip emits high energy heat that destroys the feeding vein causing varicose veins. This process deprives the vein of oxygen which ultimately closes the vein and your body eventually absorbs it. This has really become the standard of care in my opinion. It is far superior to vein stripping and sclerotherapy and slightly better than radiofrequency ablation (RFA). This is the most common method we use, usually in combination with sclerotherapy or microphlebectomy, at the Oregon Vein Center. Ablation is also recommended over compression by the American Venous Forum, an international recognized authority on venous disorders.
3. Vein Stripping
This is rarely indicated or performed now by an experienced phlebologist. This procedure is usually performed in the hospital setting and under general or regional anesthesia. Incisions are made at the groin area and at the ankle or calf. All major varicose vein branches associated with the saphenous vein are occasionally tied off and the saphenous vein is removed by pulling it from the leg. This generally results in significant pain, bruising and increased risk for wound infection. In addition, the recovery period is generally longer that other modalities. This procedure, on occasion, is still necessary particularly in patients with severely enlarged (aneurismal) veins in which case done in conjunction with high ligation. In this setting, I prefer High Ligation with EVLT done in the office with mild sedation and local anesthesia as an alternative. Recent studies have shown outcomes are equivalent without having to endure the increase cost, risk and pain associated with vein stripping.
5. Micro or Ambulatory Phlebectomy
May be done alone or conjunction with EVLT or vein stripping. Through a few millimeter incision avulsion we remove individual varicose vein clusters from your leg using hooks passed through these small incisions. Although these procedures sound painful, they cause relatively little pain and are generally well tolerated.
6. High Ligation
This is a surgical procedure, often combined with vein stripping or EVLT in which a 1-2inch incision is made in the groin where the saphenous vein is tied off just before it joins the deep vein to prevent a primary source of reflux and pressure to the leg.
7. Surface Laser or Transcutaneous Laser
This uses light at a given wavelength to target primary telangiectasia and to a lesser extent reticular veins located in the skin. This is sometimes a preferred treatment when a person does not tolerated sclerotherapy, is needle phobic, developed telangiectatic matting, hyperpigmention or had no improvement following sclerotherapy. We currently do not offer this option in our clinic.