What are the treatment options for varicose veins?
There are several different options, plus a number of new treatments.
Conventional (usual) treatments
Self-help methods
Avoid prolonged standing or sitting still. Try to "put your feet up" frequently (sit or lie down and raise the feet above the level of your hips, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood 'pooling' in the veins. Use moisturising cream to protect the skin if it is dry, flaky or itchy. (Aqueous cream is suitable and inexpensive, or there are other types available - ask your pharmacist or doctor.)
Support tights and compression stockings
These counter the extra pressure in the veins. They may help to ease symptoms such as ache, though there is little proof as to how well they work. Support tights and compression stockings may also help to prevent early complications from getting worse. To work properly, they need to be correctly fitted. They come in different strengths and sizes. Most people find that the type of compression stockings called 'below-knee class 1 (light) or class 2 (medium)' are suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and taken off when going to bed at night. Compression stockings are available on prescription or can be purchased.
Note: If you have arterial disease (poor circulation or peripheral vascular disease) in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above).
Creams and medicines
Moisturising cream can be helpful if the skin is dry, hard or itchy, or if there is eczema. Also, for eczema due to varicose veins, a short course of steroid cream may be needed.
Surgery
Different techniques can be used to remove the veins, depending on their site and severity. A surgeon will advise. Usually, the communicating veins (explained above) are tied off (ligated). Then the large varicose veins are removed or 'stripped' from the leg. Many people can be treated as day cases. One to three weeks off work may be needed afterwards, depending on your job.
Sclerotherapy
This injects the vein with a chemical that can 'sclerose' (close and seal) the vein. It is mainly used for smaller veins. The vein needs to be compressed afterwards, which involves wearing bandaging or compression stockings for a few days or weeks.
Newer treatments
Newer techniques have also been developed to treat varicose veins. Their aim is to reduce the need for traditional 'stripping' of the veins, and to reduce bruising or other possible complications of surgery. The new treatments are:
Radiofrequency ablation and endovenous laser ablation
These methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The laser or radiofrequency energy makes the vein heat up, which seals it.
Transilluminated powered phlebectomy
This is a new method of surgically removing the veins. A light is passed under the skin and the varicose veins are removed by a suction device. This reduces the number of cuts needed to remove the vein.
Foam sclerotherapy
This uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. Ultrasound is used to help guide the injection. After treatment, compression stockings are needed, and the veins will be hard and swollen for a while before they shrink down. More than one treatment may be needed.
Which treatment?
All types of surgery or injection for varicose veins have a small risk of complications, for example, damage to nearby nerves or skin. Also, it is quite common to have side-effects such as pain and bruising for a while afterwards. There is also a chance that the varicose veins can recur (come back). Ask your surgeon about the pros and cons of different treatments in relation to your own particular veins.
The new methods have not yet become 'routine' or standard practice. They need to be further evaluated before we know their long-term success rates. Currently, they are not always available on the NHS, but may become more popular in future.
Thread veins and spider veins
These do not cause the same problems as varicose veins, and do not need treating except for cosmetic reasons. They are not usually treated under the NHS. See the further information section (below) for more details about thread vein treatment.
Further information
Dermnet NZ
Online information about skin conditions and their treatment - for patients and doctors, from the New Zealand Dermatological Society. Includes information and pictures about thread veins and venous eczema ('gravitational eczema').
Website: www.dermnetnz.org
References
* Campbell B; Varicose veins and their management. BMJ. 2006 Aug 5;333(7562):287-92.* Henry & Thompson, Clinical Surgery: second edition. Elsevier Saunders, 2005. ISBN 0702027197
* Endovenous laser treatment of the long saphenous vein, NICE (2004)
* Transilluminated powered phlebectomy for varicose veins, NICE (2004)
* Radiofrequency ablation of varicose veins, NICE (2003)
* Ultrasound guided foam sclerotherapy for varicose veins, NICE (2006)
© EMIS and PiP 2008 Reviewed: 24 Oct 2008
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