Management

Treatment of varicose veins may be indicated to relieve discomfort, to prevent or ameliorate complications, or for cosmetic reasons.

Methods:

• conservative
• interventional treatment

About one-third of cases can be managed by offering common sense advice as to how to take care for their legs (1)

Assessment and treatment in a vascular service

• assessment
  • use duplex ultrasound to confirm the diagnosis of varicose veins and the extent of truncal reflux*, and to plan treatment for people with suspected primary or recurrent varicose veins
    
    
• interventional treatment
  • for people with confirmed varicose veins and truncal reflux:
    • offer endothermal ablation and endovenous laser treatment of the long saphenous vein
      • if endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy
        • if ultrasound-guided foam sclerotherapy is unsuitable, offer surgery
  • if incompetent varicose tributaries are to be treated, consider treating them at the same time
  • if offering compression bandaging or hosiery for use after interventional treatment, do not use for more than 7 days
    
    
• non-interventional treatment
  • Do not offer compression hosiery to treat varicose veins unless interventional treatment is unsuitable

*the extent of truncal reflux is the amount of backflow of blood through a main superficial vein

Notes:

• sclerotherapy - permanent obliteration of varices
• open operation - removal of varices with ligation of incompetent perforaters

Reference:

• 1) NICE (July 2013). Varicose veins in the legs - The diagnosis and management of varicose veins
• 2) BMJ. 2003 Oct 18;327(7420):911-5.