What are the treatment options?
The goals of treatment are to reduce symptoms and reduce the risk of complications. Since not all varicose and spider veins require medical treatment, the goal of treatment may be simply to improve the appearance of the affected areas.
Compression therapy and lifestyle change
Wearing properly fitting support hose (also called compression stockings) is the most conservative approach for treating varicose veins, especially when the veins are symptomatic. Compression stockings can be purchased at some pharmacies and medical supply stores and come in various styles including below-the-knee, above- the-knee and pantyhose styles. They also come in different compressions varying from 8 to 10 mmHg, up to as high as 40 to 50 mmHg. Your doctor can recommend the compression that is right for you.
Other conservative treatment methods include:
- Practicing good skin hygiene
- Losing weight if you are overweight
- Exercising regularly (especially walking)
- Avoiding prolonged periods of sitting or standing
- Elevating your legs while sitting and sleeping
When you need to stand for long periods, take frequent breaks - sit down and elevate your feet.
If you do not achieve satisfactory relief of symptoms with conservative treatment, or if the appearance of the veins is bothersome, other treatments may be offered, depending on your overall medical condition and the size and location of the veins. Other treatment options include sclerotherapy, laser and light therapy, minimally invasive procedures and surgery. These techniques are described below.
Sclerotherapy involves the injection of a solution directly into the varicose veins that cause them to collapse and disappear. Several sclerotherapy treatments usually are required to achieve the desired results.
Foam sclerotherapy is a variation of the procedure performed under ultrasound guidance that involves the injection of a foaming agent mixed with a sclerosing agent. The foaming agent moves blood out of the vein so the sclerosing agent will have better contact with the vein wall.
Sclerotherapy is a simple procedure that can be performed in the doctor’s office. Sclerotherapy can eliminate the pain and discomfort of varicose veins and helps prevent complications such as venous hemorrhage and ulceration. It is also frequently performed for cosmetic reasons.
Laser and Light Therapy
Laser and pulse-light therapy are used to heat the blood vessel to shrink it. Laser therapy is most effective for the treatment of small varicose veins and spider veins. Laser therapy may be used as an additional treatment after sclerotherapy, endovenous procedures, or surgery of larger veins. Lasers are also being used for endovenous ablation of larger varicose veins. Laser treatments may require several sessions, spaced at six-week intervals, to properly treat the vein.
High-intensity, pulsed light (photoderm or light therapy) is another treatment option. It is different than laser and pulse-light therapy because a spectrum of light is emitted during treatment, rather than a single wave-length. It can be used to selectively shrink abnormal veins including small spider veins, certain varicose veins and vascular birthmarks.
This treatment may be recommended when sclerotherapy or laser therapy does not effectively treat the vein or for patients who do not like needles.
Minimally Invasive Procedures
Endovenous thermal ablation therapy is a procedure that uses laser or high-frequency radio waves are to create intense local heat in the varicose vein. A tiny cut is made in your skin near the varicose vein (generally below the knee). Your doctor inserts a small catheter (tube) into the vein. A device at the tip of the catheter heats up the inside of the vein and closes it off. The technology is different with each type of energy source, but both forms of local heat close up the targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising. You are awake during this procedure, but your doctor numbs the area around the vein. Compared with ligation and stripping, endovenous thermal ablation results in less pain and a faster return to normal activities, with similar symptomatic improvement and cosmetic results.
Micropuncture or micro-incision or stab phlebectomy is performed in an outpatient surgery center. The physician makes a tiny incision and uses a surgical instrument or a large needle to hook the problem vein through the opening. The vein is then removed a tiny piece at a time.
Transilluminated power phlebectomy is an enhanced version of stab phlebectomy and was developed to reduce the number of incisions, pain, bleeding and scarring. The procedure involves inserting a fiberoptic light under the skin while simultaneously injecting a mixture of saline and local anesthetic. This creates a silhouette of the veins to guide the surgeon in placing a powered tissue resector. This instrument cuts the vein into smaller pieces and suctions the pieces from the space.
Surgery may be the best treatment when varicose veins are severe and associated with problems such as bleeding, or symptoms including pain or swelling. Several surgical treatments are available, including endoscopic options. Before choosing any treatment option, it is important to discuss the potential benefits, risks, and side effects with your health care provider. Surgical treatments are performed in the hospital or outpatient setting by a vascular specialist.
Ligation and stripping often are performed in combination. Vein ligation is a surgical treatment for varicose veins. In this minor procedure, a vascular specialist cuts and ties off the problem veins. Most patients recover in a few days and can resume their normal activities.
Stripping is the surgical removal of larger varicose veins through two small incisions. Stripping is a more extensive procedure and may require up to 10 days for recovery. It usually causes bruising for several weeks after surgery.