Varicose Vein Treatment: Conservative Therapy
Varicose Vein Treatment at Home
Since blood pooling primarily causes varicose veins within the veins of the leg, leg elevation to improve blood flow back to the heart can reduce swelling (edema) and help venous stasis ulcers to heal.1 Leg elevation is fairly involved, however. Patients need to elevate their legs to at least the level of their heart for 30 minutes at a time, three or four times a day.
Another at-home varicose vein treatment that has been successful is exercise. Exercises that involve the leg muscles, such as daily walking, help push blood out of the veins. Unfortunately, since the valves within the veins are already damaged, exercise is not as effective in treating varicose veins as it is in preventing them from occurring.
Static compression therapy is considered an essential component of varicose vein treatment.2 Compression stockings are tightly fitted, oversized “socks” that extend around the lower leg. Compression stockings physically prevent blood from pooling in leg veins and help prevent or treat edema. A remarkable number of compression stocking types are available; some compression stockings are very helpful for specific types of leg disease while others can make a particular condition worse. It is essential to choose the right compression stocking for the proper clinical indication.
Several medications have been used to treat varicose veins, though few have been shown to be successful in clinical trials. Some drugs, called veno-active drugs, are used to help improve the function of veins. Venoactive drugs include hydroxyethylrutoside, Escin (horse chestnut seed extract), and micronized purified flavonoid fraction. The other class of drugs to treat varicose veins is rheologic agents. Rheologic drugs change the thickness of blood, ideally to help blood flow better through the veins. Rheologic drugs include aspirin, stanozolol, pentoxifylline, Carboprostacyclin, sulodexide, and defibrotide. These medications are intended to reduce the symptoms of varicose veins such as swelling and inflammation but do not change the way varicose veins look.
Varicose Vein Treatment: Ablation
Ablation is the removal or destruction of tissue. Varicose veins are ablated in three major ways: thermal ablation, chemical ablation (sclerotherapy), and surgical removal. KEEP IN MIND WHEN SEEKING VARICOSE VEIN TREATMENT: Just treating the veins you see at the surface of the skin is not an effective treatment, you have to treat the underlying problem similar to removing a dandelion.
Thermal Ablation: Endovenous Laser Treatment (EVLT)
Endovenous laser therapy allows for treatment of varicose veins without a hospital stay. EVLT is also a great option because there is no scarring, few or no side effects and a speedy recovery from the treatment. The laser essentially heats the varicose vein, scars it and forces it to close. Your body will quickly reroute blood to other veins nearby. The closed varicose vein will scar down to something as fine as a piece of hair and not be visible under ultrasound six months after varicose vein treatment.
The procedure can be completed in 15-45 minutes depending on the length of the varicose vein being treated. After a numbing agent is applied, a thin fiber is inserted into your skin using a small needle (requiring no stitches). Before turning the laser on, a numbing solution is injected, surrounding the entire vein that is being treated. The laser targets only the vein and not surrounding tissue. You will typically notice improvements right away. These upgrades increase with time.
Thermal Ablation: Radiofrequency Ablation
Your vein specialist will use radiofrequency energy to heat and seal your vein. Much like EVLT, you perform radiofrequency ablation with a small needle stuck in your skin over the vein. As you can see in this animation, a tube or catheter is inserted into the vein. Radiofrequency energy is then directed and used to heat the vein, causing it to scar.
Typically, you can perform this procedure with only mild sedatives and local anesthesia. After removing the catheter, as you can see in the animation, the varicose vein closes immediately. There is a shorter recovery period, and it is considered less painful than surgery. It is important to note that EVLT and Radiofrequency Ablation do not directly treat branch varicose veins. The branch varicose veins seen at the surface of the skin are too small and tortuous to guide a catheter through. If those branch varicose veins do not close after the ablation treatment, your doctor can perform a secondary procedure like ultrasound-guided sclerotherapy or ambulatory phlebectomy.
Ultrasound Guided Varicose Vein Sclerotherapy
Sclerotherapy is used to treat smaller varicose veins. Your vein specialist will use ultrasound to locate the source of the varicose vein(s). Incidentally, ultrasound is a painless, risk-free procedure used to see tissue within the body—the same technology used in pregnant women to visualize unborn fetuses. The vein specialist will then insert a small needle into the vein, again using ultrasound. The vein specialist then injects a chemical that destroys the vein. The vein walls collapse, sealing the vein. The body reroutes blood flow to surrounding, healthy veins. The destroyed varicose veins shrink and are naturally absorbed by your body over time. Sclerotherapy treatment usually takes about 30 to 60 minutes.
Phlebectomy (Surgical Varicose Vein Removal)
Phlebectomy is the surgical removal of a vein (phleb = vein, -ectomy = surgical removal). Phlebectomy is a secondary procedure, usually performed after ablation therapy and only treats the smaller branch varicose veins. Phlebectomy of varicose veins is an outpatient or ambulatory procedure, which means no hospital stay is required and it can be performed under local anesthesia and mild sedatives in a vein specialist’s office. During phlebectomy, the vein specialist makes a small incision in the skin and pulls out the affected vein. There are several variations and approaches, but the basic result is the same: the vein is physically removed. Phlebectomy lasts 30 to 90 minutes, depending on the treatment area. After the procedure, your vein specialist will encourage you to walk regularly and wear compression stockings.
- Abu-Own A, Scurr JH, Coleridge Smith PD. Effect of leg elevation on the skin microcirculation in chronic venous insufficiency. J Vasc Surg. Nov 1994;20(5):705-710.
- De Araujo T, Valencia I, Federman DG, Kirsner RS. Managing the patient with venous ulcers. Ann Intern Med. Feb 18 2003;138(4):326-334.
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