How to treat varicose veins

Varicose veins are not only an aesthetic problem, but also a health problem. Varicose veins are a clear manifestation of chronic venous insufficiency , thought to be caused by a remodelling of the venous wall, which gives it elastic properties that are different from healthy veins¹. Varicose veins are usually the result of venous dilatation, venous valve damage or both, although they may also be the result of deep vein thrombosis¹.

Risk factors include family history of venous disease: female sex, older age; chronically increased intra-abdominal pressure due to obesity, pregnancy, chronic constipation, or a tumor: and prolonged standing.²

How are they treated?

Varicose veins may lead to complications such as infections, ulcers and the appearance of thrombi² . It is therefore very important to treat them as soon as possible³. When selecting a treatment, the patient's symptoms and preferences should be given consideration. In the initial stages of the disease, conservative treatment is preferable. It consists of compressive therapy, resting with legs elevated and lifestyle changes: physical exercise, reducing cardiovascular risk and avoiding swelling of the legs. It is also important to avoid modifiable risk factors such as being overweight². These steps are reinforced by the use of venotonic medication to relieve symptoms, in particular oedema.⁴ They act on macro- and microcirculation, venous wall and valves, decreasing inflammatory reaction and modifying the mechanisms that trigger venous hypertension. Due to poor compliance with elastic compression therapy in hot countries, venoactive medication is the only available alternative for the treatment of early-stage CVD⁵.

Can varicose veins be removed?

In cases where varicose veins are at a more advanced stage, surgical treatment is required, with the objective of eliminating blood reflux, restoring normal circulation and eliminating the varicose veins to suppress symptoms and to avoid complications^2,4. The applied surgical technique depends on the type of varicose veins and on each specific case, taking into consideration the possible complications of the treatment. The most frequent surgical techniques are²:

• Thermal ablation:destroys the damaged veins by using a laser externally or by introducing it into the vein through a catheter². The two options are:
  • External laser thermal ablation: works for  “spider veins”(telangiectasias)².
  • Endovenous thermal ablation (with laser or radio waves): works for larger calibre veins².
• Endovenous sclerotherapy: consists of injecting, with the help of ultrasound, a substance that produces an inflammation, with the consequent occlusion of the vein. It is mainly used in small (1-3mm) to medium (3-5mm) size veins ².
• Surgery: The surgical strategy consists of interrupting the reflux in the saphenous veins by removing them. Although widely used, it has recently been replaced by newer techniques such as thermal ablation or sclerotherapy which offer faster recovery². Laser thermal ablation is better tolerated than sclerotherapy and surgery, has fewer adverse effects and has similar effectiveness².

Surgery has long been considered the best treatment for varicose veins. Recently however, new diagnostic techniques such as Echo-Doppler have been developed that have contributed to the development of new surgical treatments that are less aggressive, but equally effective. Over time, the concept of the best treatment for varicose veins has changed to the best option for each patient⁶.