Natural Treatments for Varicose Veins

What are Varicose Veins?

The word “varicose” comes from the Latin word “varix”, meaning “twisted”. Varicose veins are enlarged, twisted veins that are usually bluish purple.Small, one-way valves in veins ensure blood only flows towards the heart. In some people, these valves become weakened and blood collects in the veins, causing them to abnormally enlarge.Varicose veins are most common on the legs, because leg veins must work against gravity. Standing increases pressure on leg veins.Varicose veins are a common condition in the United States. Up to 25 percent of women are affected and up to 15 of men are affected.

Although in some people, varicose veins can be a cosmetic concern, in other people, they can cause swelling and uncomfortable aching, heaviness, or pain or be a sign of heart disease or circulatory disorders. If left untreated, varicose veins may lead to serious complications such as phlebitis (inflammation of the veins), skin ulcers, and blood clots.

What Causes Varicose Veins?

• Hormonal changes during pregnancy and menopause.
• Being overweight increases the pressure on veins.
• Prolonged sitting or standing restricts circuluation and puts added pressure on veins.
• Chronic constipation
• Genetics
• Aging

Natural Treatments for Varicose Veins

These are some of the natural treatments that have been explored for varicose veins. Many of them are believed to work by strengthening veins, which reduces fluid leakage from vessel walls. At any time, if varicose veins become swollen, red, or tender and warm to the touch, or if there are sores, ulcers, or a rash near the varicose vein, see your doctor.

Horse Chestnut Extract

The herb horse chestnut (Aesculus hippocastanum) is one of the most widely used natural treatments for varicose veins and chronic venous insufficiency, a related condition.The active constituent in horse chestnut is a compound called aescin. Aescin appears to block the release of enzymes that damage capillary walls.In 2006, researchers with the respected Cochrane Collaboration reviewed studies involving the use of oral horse chestnut extract or placebo for people with chronic venous insufficiency.

The researchers found an improvement in the signs and symptoms of chronic venous insufficiency with horse chestnut extract compared with placebo. Horse chestnut extract resulted in a significant reduction in leg pain and swelling compared with a placebo.Adverse events were usually mild and infrequent. The researchers concluded that based on the evidence, horsechestnut extract was an effective and safe short-term treatment for chronic venous insufficiency. None of the studies, however, evaluated whether the extract could reduce the appearance of varicose veins.Whole horse chestnut is considered unsafe by the FDA and can lead to nausea, vomiting, diarrhea, headache, convulsions, circulatory and respiratory failure, and even death. Tea, leaves, nuts, and other crude forms of the horse chestnut plant should also be avoided.

Manufacturers of horse chestnut products remove the toxic component, esculin. These products appear to be safe, as there have been few reports of harmful side effects despite being widely used in Europe.People with kidney or liver disease and bleeding disorders should avoid horse chestnut. The safety of horse chestnut in pregnant or nursing women or children has not been established. Horse chestnut should not be combined with aspirin, Plavix (clopidogrel), Ticlid (ticlopidine), Trental (pentoxifylline), Coumadin (warfarin), and other anticoagulant (”blood-thinning”) drugs unless under medical supervision as these medications may increase the effect of the medication.
 

Grape Seed and Pine Bark Extracts

The extract of grape seeds (Vitis vinifera) and pine bark (Pinus maritima) both contain oligomeric proanthocyanidin complexes (OPCs), antioxidants that appear to strengthen the connective tissue structure of blood vessels and reduce inflammation. Studies suggest that OPCs help people with various veins. Grape seed extract should not be confused with grapefruit seed extract.The most commonly reported side effects are digestive complaints such as nausea and upset stomach.

People with autoimmune conditions, such as rheumatoid arthritis, multiple sclerosis, and Crohn’s disease, should not take pine back or grapeseed extract unless under a doctor’s supervision because of its effects on the immune system. The safety of pine bark and grapeseed extracts have not been established in pregnant or nursing women or children.Pine bark or grapeseed extracts should not be combined with medications that suppress the immune system or with corticosteroids, unless under medical supervision.

Butcher’s broom

A plant in the lily family, Butcher’s broom (Ruscus aculeatus) is also known as box holly or knee holly. It contains ruscogenins, constituents believed to strengthen collagen in blood vessel walls and improve circulation. This is thought to tighten weak, stretched vessels such as those associated with varicose veins.Side effects of butcher’s broom may include digestive complaints such as indigestion or nausea. People with high blood pressure or benign prostate hyperplasia should not take butcher’s broom without first consulting a doctor. The safety of butcher’s broom in pregnant or nursing women or children has not been established. Butcher’s broom should not be taken with medication for high blood pressure, benign prostate hyperplasia, or MAO inhibitors unless under medical supervision.

Reflexology

Reflexology is a form of bodywork that focuses primarily on the feet. One small study compared reflexology with rest in 55 pregnant women. Reflexology significantly reduced leg swelling.Pregnant women should consult their doctor before having reflexology. Some sources say that reflexology should not be done during the first trimester.

Varicose Veins and Telangietasia

Some 24 million Americans have varicose veins. In fact, 72 percent of all women and 42 percent of men will have the unsightly leg bulges by the time they reach their 60s. Not only can varicose veins make thighs and calves look unappealing, they can cause pain and numbness. Beth Israel Deaconess Medical Center offers a variety of treatments for varicose veins, including a minimally invasive option called The Closure Procedure. Endovascular surgeons at BIDMC can help determine the best treatment for you.

What causes varicose veins?

Your legs are made up of a network of veins and vessels that carry blood back to the heart. Sometimes, the vein valves become damaged or diseased, and the flow of blood is reversed, sending it down toward the feet. The blood can pool creating pressure in the leg veins which can cause them to become dilated or varicose.

Who is at risk for varicose veins?

Varicose veins tend to run in families, implying a genetic link. Also, women who have had multiple pregnancies are at greater risk, as are men and women who are obese or have occupations that force them to spend a lot of time on their feet.

What are the traditional treatments for varicose veins?

Staying off your feet and elevating the legs can help the pain and numbness caused by varicose veins. Compression stockings can also provide relief. But these treatments won’t cure the underlying problem that leads to bulging veins.Traditional surgery, called vein stripping, involves removing a portion of the saphenous vein. This requires two incisions—one in the groin crease and one in the calf. A stripper tool is threaded through the diseased vein and pulls the diseased vein out of the leg. Patients usually can go back to their normal activities after 3 days, with the utilization of compression stockings. In another procedure called Ambulatory Micro- Phlebectomy, doctors remove smaller varicose veins through a series of tiny skin punctures.

What is The Closure Procedure?

The Closure Procedure is a newer way of treating varicose veins. Using ultrasound, surgeons position a catheter into the diseased vein through a small opening in the skin. This tiny catheter delivers radiofrequency (RF) energy to the vein wall. As the catheter is removed, the vein wall heats up, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins.

What are the benefits of The Closure Procedure?

The procedure itself takes about one hour and is done under local anesthesia in our office, no hospital trip is required. Patients usually return to their normal activities the following day. Studies show those who have the Closure Procedure report less post-operative pain than with traditional vein stripping with minimal to no scarring, bruising or swelling. In fact, 98 percent of patients who have undergone The Closure Procedure are willing to recommend it to a friend or family member.

Does insurance cover The Closure Procedure?

Most insurance plans do cover The Closure Procedure for those who have pain in their legs and feet as a result of varicose veins.

Venous disease

This  shows significant varicosities in the distribution of the long saphenous vein.  There were no features of venous hypertension. Percussion and tourniquet tests showed sapheno-femoral incompetence.  Varicose veins affect approximately 20% of the adult population. They are more prevalent in women and overall they represent a significant health problem that consumes a large amount of health care funding. Approximately 20% of varicose veins are recurrent, a proportion of which result from an inadequate initial operation.

A complete assessment of a patient with varicose veins should be based on the history, examination and hand-held doppler assessment. Additional investigations such as duplex ultrasound or varicography might also be required. The history will highlight cosmetic concerns, pain and possible night cramps. Other important factors are – periods of immobilisation, lower limb fractures or ‘white limb of pregnancy” which might suggest a previously unidentified deep venous thrombosis. On examination of the distribution of the varicose veins might suggest the site of valvular incompetence. This can be confirmed clinically by the use of percussion or tourniquet tests. The site of valvular incompetence can also be identified by the use of a hand-held doppler probe. When placed over the sapheno-femoral or sapheno-popliteal junction, calf compression produces an identifiable forward flow. On release of the compression a transient (<1 second) retrograde flow signal is normally identified. In patients with valvular incompetence a prolonged retrograde signal is audible. In most patients with primary LSV varicose veins the above constitutes an adequate assessment. However, in patients with recurrent varicose veins, SSV varicose veins, calf perforators or doubts over the deep venous system, duplex ultrasound should be considered. Primary sapheno-popliteal ligation should not be performed without pre-operative mapping as the position of termination of the SSV is highly variable and in up to 25% of patients it does not enter the popliteal vein.

The treatment of varicose veins varies between surgeons but a few general comments can be made. In a proportion of patients with minor varicosities and no features of venous hypertension (varicose eczema, lipodermatosclerosis or ulceration) reassurance might be all that is required. Compression hosiery with a pressure of 40, 30 and 20 mmHg at the ankle, mid-calf and knee respectively will reverse venous hypertension and prevent complications. However, most patients find stockings uncomfortable and are often not satisfied with them as a long-term treatment option. The role of sclerotherapy is controversial. It often fails in the presence of major valvular incompetence but may be useful for the treatment of small residual varicosities after surgery. Complications of sclerotherapy include pain, ulceration, thrombophlebitis and skin staining.

Surgery is the mainstay of treatment for varicose veins in many patients. LSV varicosities are often treated by sapheno-femoral flush ligation, LSV strip and avulsions. Adequate ligation of all tributaries of the sapheno-femoral junction, beyond their first branch reduces the risk of recurrence. Most surgeons will strip the LSV to the knee. Whether it should be stripped proximally or distally is unproven. Stripping to the ankle is associated with an increased risk of damage to the saphenous nerve resulting in a persistent saphenous neuralgia. Stripping increases the risk of haematoma formation, but reduces the risk of recurrent varicose veins. As mentioned above, sapheno-popliteal ligation requires preoperative marking. Stripping of the SSV is performed less frequently as it is associated with a significant risk of sural nerve damage. Open ligation of perforator vessel is performed rarely today as it often results in delayed wound healing. Recent interest has been shown in endoscopic sub-fascial ligation of these vessels.

Conventional Medicine for Varicose Veins

Varicose veins can appear anywhere in the body but most often affect legs and feet. Although they can be painful and disfiguring, they are usually harmless. When inflamed, they become tender to the touch and can hinder circulation to the point of causing swollen ankles, itchy skin, and aching in the affected limb.Varicose veins are a relatively common condition, and for many people they are a family trail. Women are twice as likely as men to develop them. In the United States alone, nearly 10 percent of all adult men and 20 percent of adult women are affected by them to some degree.

Conventional Medicine

Superficial varicose veins normally do not require medical attention. To relieve the discomfort, your doctor may recommend elastic support stockings. Support stockings help your leg muscles push blood upward by concentrating pressure near the ankles. Put them on before you get out of bed in the morning. Raise your legs in the air and pull the stockings on evenly; they should not feel tight in the calf or groin. You should wear them all day.

To alleviate occasional swelling and pain, an over-the- counter anti-inflammatory drug such as aspirin or ibuprofen are usually prescribed. If you notice skin around a varicose vein becoming ulcerous or discolored, or if you have continuing pain with no obvious outward signs, contact a doctor at once about the possibility of deep varicose veins.

Varicose veins can be eliminated by one of several methods. Spider veins can be removed through laser treatment. A mild case of superficial varicose veins can be treated by sclerotherapy: A chemical known as a sclerosing agent is injected into the vein to collapse its walls so it can no longer transport blood. More severe cases may merit surgical removal, or stripping. Unfortunately, no treatment can prevent new veins from becoming varicose. Before pursuing a particular treatment, discuss all options with a dermatologist or vascular surgeon.

Alternative Choices

To cope with varicose veins, try a two-pronged strategy of natural remedies to ease the discomfort and preventive maintenance to keep your body fit and strong.

Acupuncture and Acupressure

Particular part/point of the body may be pressed for ten minutes daily. Cannot help aesthetically, only prevents the situation from worsening.

Aromatherapy

Blend 12 drops each of cypress and geranium essential oils in four ounces of a carrier oil such as almond, soy or sunflower. Gently apply the mixture to the legs by stroking upward, in the direction of the heart. Don’t massage directly on the veins. Instead, massage the surrounding area and gently stroke the oil over the veins.

Oil of rosemary (Rosmarinus officinalis) massaged gently into an affected area may help stimulate circulation by causing capillaries to dilate. Oils of cypress and chamomile (Matticaria recutita) may soothe swelling and inflammation and help relieve pain.

Color Therapy

Use red and yellow all over the affected area for thirty minutes once per day. In cases of ulcers in the legs use blue light radiation for thirty minutes followed by ultraviolet for forty-five minutes, every day for ten to sixty days.

Diet and Supplements

A high-fiber diet helps prevent straining of your stool, which can build up pressure and aggravate varicose veins. It is recommended that you consume at least 30 grams of fiber a day. To accomplish this, build your meals around whole grains, legumes, fruits and vegetables, adding these foods to your diet as often as possible. Eat plenty of blackberries and cherries. They are rich in compounds that may prevent varicose veins or lessen the discomfort they cause. (See juice therapy for recommendations about fruit juices.)

Vitamin A In the form of beta carotene, 25,000 IU for skin integrity and to speed varicose ulcer healing.B Complex One comprehensive tablet plus a tablespoon of brewer’s yeast daily to help maintain strong blood vessels.Vitamin C and Bioflavonoids 1,000 to 5,000 milligrams of vitamin C and 100 to 1,000 milligrams of bioflavonoids in divided daily doses to aid circulation, promote the healing of sores, and strengthen vein walls to prevent dilation.

Among bioflavonoids, rutin is used routinely to treat varicose veins. It is present in many foods, including citrus fruits, apricots, blueberries, blackberries, cherries, rose hips, and buckwheat. Another bioflavonoid, quercetin, has shown promise in treating varicose veins.

Vitamin E 300 to 800 IU in gradually increased dosages to improve circulation, reduce susceptibility to varicose veins, relieve pain, and, sometimes, correct varicosities. Topical applications of vitamin E squeezed from capsules often relieves localized irritation and speeds the healing of varicose ulcers. (Although the Daily Value for vitamin E is only 30 IU, 300 to 800 IU a day is safe for most people. If you suffer from moderate coagulation factor deficiency, however, don’t take this much vitamin E. It can cause dangerous bleeding in people who have this condition.)Lecithin One tablespoon of granules daily (or two capsules with each meal) to emulsify fats and aid circulation.Tissue Salts Two tablets of 6XCalc.Fluor. each morning and evening to improve the elasticity of blood vessel walls.

Zinc 50 milligrams daily to assist with healing and collagen formation and to help maintain the proper concentration of vitamin E in the blood.

Preferred Foods:

Whole foods diet with emphasis on the following foods: fresh fruits, including berries and cherries, and citrus fruit making sure to nibble on the inside of the rinds, whole grains especially buckwheat and millet, garlic, onions, ginger, and cayenne pepper. Eat plenty of fish and cut down on red meat as much as possible. Moderately restrict fats and refined carbohydrates in diet.

Foods to avoid:

Sugar, salt, alcohol, fried foods, processed and refined foods, animal protein, cheeses, and ice cream.

Chiropractic

Chiropractors combine diet and lifestyle therapy with physical manipulation of the skeletal system to control varicose veins. Manipulation to relieve strain on the pelvis, for example, is intended to improve the flow of blood and other fluids through the body.

Herbal Therapies

Witch hazel - Application of a witch hazel ointment three or more times is necessary for two or more weeks before results can be expected. (Witch hazel may cause minor skin irritation in some people when applied topically; this herb is not recommended for internal use.)

Horse chestnut - Can be used both internally and as an external application for problems of venous circulation, including varicose veins. (Horse chestnut should be avoided by anyone with liver or kidney disease. Its internal use is also contraindicated during pregnancy and lactation. Topically, horse chestnut has been associated with rare cases of allergic skin reactions. Since circulation disorders and trauma associated with swelling may be the sign of a serious condition, a health care professional should be consulted before self-treating with horse chestnut.)

Bilberries - Support normal formation of connective tissue and strengthen capillaries in the body, and in this way help prevent varicose veins.

Butcher’s broom - Tons veins while reducing inflammation. Can also be prepared as tea.

Gotu Kola - Strengthens blood vessels and improve peripheral circulation.

Ginkgo (Ginkgo Biloba) - Strengthens blood vessels and improve peripheral circulation.

Hawthorn (Crataegus laevigata) - Strengthens blood vessels and improve peripheral circulation.

To disperse buildup of a protein that makes skin near varicose veins hard and lumpy, try eating more cayenne (Capsicum frutescens), garlic (Allium sativum), onion, ginger (Zingiber officinale), and pineapple, which contains bromelain, an enzyme that promotes breakup of fibrin.

Herbal Tea

Hawthorn berries 3 parts
Yarrow 2 parts
Horsechestnut 3 parts
Ginger 1 part
Prickly ash bark 2 parts
Use two teaspoonfuls of the mixture. Infuse for fifteen minutes. Drink three times daily. External applications of Camomile, Comfrey, Oatstraw, White Oak Bark, or Witch Hazel are believed especially beneficial.Aloe Vera gel can be used to soothe itchy or irritated varicosities.

Homeopathy

• Hamamelis: Tincture or lotion may be applied locally at night. Hamamelis 3X every three hours when veins are affected.
• Pulsatilla: 3X is recommended every eight hours after child delivery.
• Carbo vegetabilis: When constipated and with poor circulation. In cases of ulcers of varicose veins.
• Mercurius sol: if accompanied by infection, pus, and foul-smelling discharge.
• Lachesis: Blue color in area mainly on left side. Belladonna, 12x or 12c potency four times a day, is recommended for red, hot, swollen, and tender varicose veins.
• Ferrum metallicum:if your legs look pale but redden easily and walking slowly relieves the weak, achy feeling.
• Arnica 30c
• Aconite napellus 6c

Hydrotherapy

It is beneficial to alternate between hot and cold baths. This is believed to stimulate circulation in the legs. It is easy to do this. You need two buckets or plastic wastebaskets tall enough to submerge the legs up to the knees. Fill one container with enough comfortably hot water to cover the lower legs and the other container with the same amount of cold water. Add 2 tablespoons of epsom salts per quart of water or you can add an aromatherapy oil to the water. Soak your feet and legs in the hot water for about three minutes, then immerse them in the cold water for about 30 seconds. Repeat three times, finishing with the cold soak. Perform this treatment once a day for at least one month to see results. If you have diabetes, use warm (not hot) water.Sponging or spraying legs with cold water can relieve aches and pain from superficial varicose veins.

Juice Therapy

Fresh fruit juices can be very helpful for those with varicose veins. Dark-colored berries such as cherries, blackberries and blueberries contain anthocyanins and proanthocyanidins, pigments that tone and strengthen the walls of the veins. Pineapples are rich in the enzyme bromelain, which helps prevent blood clots, an uncommon but serious complication of varicose veins.

Juicing provides these nutrients in much higher concentrations than you can get by just eating the fruits. Drink eight ounces of fresh berry or pineapple juice, alone or diluted with another fruit juice, once or twice a day for maximum benefit.

One or two glasses daily of fresh fruit or vegetable juices- especially any combination of apple, beet, carrot, celery, citrus, parsley, or pineapple-and dietary supplements may be helpful in preventing and treating varicosities.

Exercise

Maintaining your overall fitness, both nutritionally and physically, is most essential to preventing varicose veins from developing. Any program of regular exercise stimulates circulation, improves muscle tone, and helps prevent varicosities. However, high-impact aerobics, jogging, strenuous cycling, or any intense activity may increase blood pressure in the legs and accentuate varicose veins. Walking and swimming are considered excellent therapy, as are gentle leg-muscle stretches and utilizing a rocking chair while watching television.

Lying flat on the floor and resting the legs on a chair seat or straight up against a wall for 2 minutes drains blood from swollen veins. Elevating the feet higher than the hips with a recliner or ottoman, and raising the foot of the bed a few inches, helps blood flow back to the heart from the legs. Start your morning with a brisk walk or finish your day with a swim or bike ride.

You can help control varicose veins with a program of specially designed exercises, under the direction of a trained exercise therapist who is knowledgeable about the condition’s particular needs.

Massage

Regular massage can significantly alleviate discomfort associated with varicose veins. A trained massage therapist starts at the feet and massages your legs up to the hips and along the lymphatic system, to mobilize congested body tissues.

If you do the massage yourself, remember to never massage directly on varicose veins. A general leg massage can help reduce swelling in the veins. Sit up comfortably on a sofa or bed, with your legs raised slightly on a pillow. Now work up the entire leg from the ankle to the upper thigh. (Remember not to touch the varicose veins.) Do this daily for about five minutes on each leg.

Reflexology

Working your hands or feet may help with varicose veins. Massage the whole feet or hands and press the following points three times per day for five minutes each point after massaging the whole feet, (adrenal and parathyroid gland, digestive system (especially the liver), spine, heart and sciatic nerve.)

Schuessler Tissue Salts

Calcarea fluorica: 6X when the veins are dilated, or when there is a tendency to varicose ulcerations or bluish discoloration of the tissues or muscular weakness.
Ferrum phosphorica: 6X for inflammation of the veins, red streaks following the course of vein, throbbing pain along a vein. Can be used as alternative to calcarea fluorica. Also good for those suffering from inflammation and those who are advanced in years.
Magnesium phosphorica: 6X for severe, acute, cramplike, spasmodic pains. Also for those suffering from flatulence or neuralgia.

Yoga

Yoga’s stretching and relaxation techniques can be particularly beneficial for varicose veins. Certain positions, such as the Plow, Corpse, and Half Shoulder Stand, promote circulation and the drainage of blood from the legs. The deep-breathing exercises in yoga may further alleviate discomfort by getting more oxygen into the bloodstream.

A special breathing exercise can help ease pain from varicose veins. Start by lying on your back on the floor, arms at your sides, with your feet resting above you on a chair. Breathe deeply through your nose using the belly breath. Gravity helps pull blood from your legs. The deep breathing creates a pull in your chest cavity that also draws blood from the legs. Fresh blood then enters your legs, easing the pain. Do this exercise once a day for about ten minutes.

Folk Remedies

• Apply a cloth saturated with apple cider vinegar on the varicose veins for 30 minutes twice a day. Follow this with a drink of 2 teaspoons of the vinegar in a glass of water.
• Prepare a salve by stirring 2 cups of chopped calendula flowers, leaves, and stems into an equal amount of melted lard. Let the mixture stand for 24 hours. Reheat and strain. Coat this over your varicose veins and let it stand overnight.
• Steep crushed, fresh violet leaves and flowers or marigold flowers in boiling water. Apply compresses of the liquid. Eat a few fresh marigold petals every day. This treatment is believed to shrink varicosities and nourish the veins.
• Prepare a poultice of bruised cabbage leaves, rotten apples, chopped brown onions, or a half-and-half blend of cod liver oil and raw honey. Apply this overnight. This is believed to heal varicose sores. To one pint of warm water, add three tablespoons of sugar and two tablespoons of apple cider vinegar. Take two ounces of this mixture everyday.
• Rub your legs with full- strength vinegar. Mix two tablespoons of vinegar with honey and drink it.

Common Sense Recommendations

• Exercise regularly.
•  Staying fit is the best way to keep your leg muscles toned, your blood flowing, and your weight under control.
• Eat foods low in fat, sugar, and salt. Drink plenty of water. Take supplements of vitamins C and E.
• If your job requires you to be on your feet constantly, stretch and exercise your legs as often as possible to increase circulation and reduce pressure buildup.
• If you smoke, quit. Smoking may contribute to elevated blood pressure, which in turn can aggravate varicosity.
• If you’re pregnant, sleep on your left side rather than on your back. This minimizes pressure from the uterus on the veins in your pelvic area. It also improves blood flow to the fetus.
• To ease painful swelling and inflammation, rest frequently, wear support stockings, and take one or two aspirin or ibuprofen tablets daily until the condition clears.
• If you like to sit with your legs crossed, cross them at the ankles rather than the knees for better circulation.
• Take occasional breaks and put your feet up. Periods of rest with your feet a few inches above your heart level let gravity work in your favor, helping pooled blood drain from your legs.
• Avoid high heels in favor of flat shoes.
• Wear loose clothing. Tight garments can restrict venous blood flow to leave blood pooled in the legs. Particularly harmful are girdles or pantyhose too snug in the groin area, garters, calf-hugging boots, or waist-cinching belts.
• Take an aspirin every day. This will thin the blood and prevent blood from clotting. (Consult your doctor if you are taking any heart medication or other medication for blood clotting.)

Treatment of varicose veins by endovenous laser therapy

Conventional treatment of saphenous vein reflux by surgical ligation or stripping leads to appreciable trauma, disruption of activities, scarring and high late recurrence rates.1 Alternative, non-surgical techniques are gaining increasing acceptance. Endovenous laser therapy (EVLT) provides a percutaneous technique to destroy larger diameter saphenous veins as an outpatient procedure under local anaesthesia, with minimal disruption of activities and no surgical trauma.2-5 In this article, we describe our early results for 404 saphenous veins in 308 patients treated by EVLT and followed up by ultrasound surveillance.

Methods

Two of us who are surgeons used essentially identical techniques for EVLT. The procedure was introduced in January 2002 by K M and adopted in November 2002 by R F, and follow-up for analysis continued until August 2005. Median times for each surgeon’s experience were 31 months for K M and 22 months for R F.Approval was obtained from the Epworth Hospital ethics committee for endovenous treatment of varicose veins.Patients and veins treatedEVLT was offered to patients where preliminary ultrasound scanning showed great or small saphenous reflux with a straight section of saphenous vein of diameter greater than 5–6 mm (30% of all patients referred with varicose veins). Most of the remainder were treated by ultrasound-guided sclerotherapy, as few patients elected to be treated by surgery.

There were 308 patients treated for varicose veins with saphenous reflux (K M, 190; R F, 118), consisting of 189 women (61%) and 119 men, with an age range from 15 to 89 years (median, 52 years). Great and small saphenous veins of the same limb were treated at the one procedure in eight patients and saphenous veins from each limb were treated in 88 patients, initially as separate procedures, but then always at the one session. In total, 404 saphenous veins (334 great; 70 small) were treated in 396 limbs.The clinical, aetiological, anatomical, and pathophysiological (CEAP) classification was used to assess the limbs.There were 361 limbs with uncomplicated varicose veins (C2–3, 91%) and 35 limbs with complications (C4–6), due to lipodermatosclerosis (n = 26), healed past venous ulceration (n = 6) or active ulceration (n = 3). Primary disease was present in all limbs, and none had features of the post-thrombotic syndrome. There was persistent or recurrent reflux after past saphenous vein surgery by other surgeons in 20 limbs (15 for great saphenous and 5 for small saphenous disease).Duplex scanning performed by specialist vascular sonographers linked to the surgical units was used to select saphenous veins suitable for EVLT. Limbs were evaluated to detect superficial, deep and perforator reflux, mark the site and extent of disease, and measure the length and diameters of refluxing saphenous veins as previously described. All limbs treated had reflux through the corresponding saphenous junction or other major connections to deep veins. The lengths of veins treated ranged from 5 to 55 cm (median, 34 cm) and their diameters from 5 to 20 mm (median, 8 mm).

Technique for EVLT

EVLT was performed using the Diomed 810 nm diode system (Diomed, Inc, Andover, Mass, USA). It is not necessary to sedate the patient. Ultrasound guides the various stages using a 12–5 MHz linear array probe for most limbs. The distal end of the saphenous vein to be treated and the saphenofemoral or saphenopopliteal junction are marked. The limb is prepared as for a surgical operation and the operator is gowned and gloved.The ultrasound probe in a sterile sheath shows the vein in a longitudinal view. The puncture site is infiltratedwith 1% plain xylocaine, a stab is made to accommodate a sheath, a 19-gauge angiogram needle punctures the vein under vision, a 0.035-inch safety-J guide wire is passed up the vein to the saphenous junction, and a 45-cm-long 5F sheath is passed over the wire to the junction. Ultrasound is used to guide injection of 7–8-mL aliquots of a 0.2% xylocaine with adrenaline solution through a 25-gauge needle into the fascial space surrounding the vein at intervals down its length. The fluid compresses the vein onto the probe and acts as a heat sink for laser energy, protecting adjacent structures as well as providing anaesthesia.

The guidewire and sheath dilator are removed, and a laser probe is passed up the sheath. Markers on the probe allow 2 cm of probe to extend beyond the sheath. Settings are selected to deliver 14 W of power at a continuous rate. The probe tip is placed 2 cm below either saphenous junction and the position of the probe below the junction is confirmed by transillumination. The probe is then activated and withdrawn at about 3 mm/s (a faster rate was used early in the study).

After completion of EVLT, the limb is placed in firm compression bandages and the patient is immediately ambulated. Pain is usually well controlled by oral analgesics, and most patients are able to resume normal activities by the next day.Further treatment by ultrasound-guided sclerotherapy for residual distal veins was required after 80% of procedures, usually performed 1–3 weeks after EVLT, to control tributaries (70%) and the distal saphenous vein (10%). No surgical procedure has been required in any limb.

Ultrasound surveillance

It is essential to repeat the ultrasound scan at 3–5 days after the procedure to confirm that the treated vein has been occluded, determine residual veins to be treated, and exclude deep vein thrombosis. It is then desirable to repeat the scan at 6 weeks, then 6-monthly for 2 years, then annually, looking for occlusion or obliteration, or for recanalisation of the vein.

Statistical analysis

is Follow-up with serial ultrasound scans atthe above intervals was used for survival analysis. Success was defined as continuing occlusion or obliteration without reflux in any segment of treated vein, as determined by ultrasound.Primary failure occurred if there was persistent or recurrent saphenous vein reflux at any time during follow-up, and was defined as failure to occlude the lumen, or recanalisation with reflux in a part or all of the treated saphenous vein, whether or not this was associated with clinical persistence or recurrence of varicose veins.

Secondary failure was defined as failure to occlude the lumen, or recanalisation and reflux after primary failure, either because of a decision for no further treatment or if further treatment by ultrasound-guided sclerotherapy was unsuccessful.Data were progressively censored if veins remained occluded at the patient’s last study visit. The number of veins available for review at various intervals through the study (as patients were seen at the most recent visit, were lost to follow-up or died) .Univariate Kaplan–Meier life table analysis was used to calculate primary and secondary ultrasound success and failure rates. The time to failure was the difference between the date of EVLT and the date that recurrent reflux was demonstrated at follow-up scans. All patients presented for the first post-procedure scan at day 3–7; if failure was noted at this scan, then this was used as the failure date for survival analysis, although it is probable that the procedure had failed from the time it was performed. If a patient noted to have recurrent saphenous reflux had missed a previous scheduled visit, then failure due to recurrent saphenous reflux was dated back to the time of that missed visit.

Multivariate Cox regression proportional hazard analysis was used to correlate success or failure independently with various covariates relating to the patients, limbs and treated veins. These were age, sex, side, clinical CEAP category (C2–3 v C4–6), treating surgeon (K M or R F), vein treated (great or small saphenous), primary disease without previous treatment or recurrence after previous surgery, time to the date of procedure from the date for commencement of each surgeon’s experience (days), length of vein treated (centimetres), representative diameter of the vein (millimetres), and rate of withdrawal of the laser probe (millimetres per second).To avoid linearity assumptions, we categorized continuous predictor variables (age, surgeon experience, length of vein, diameter of vein, and rate of withdrawal). We selected categories based on quartiles of the variable’s distribution, independently of its association with the outcome variable. We used a likelihood-ratio χ2 test to assess the contribution of each predictor variable in a final model.The unit of analysis for Cox proportional hazard regression was the vein. We used the Huber–White sandwich estimator of variance to accommodate clustering of veins within the same patient. Each vein inherited the higher-level characteristics of its “parent” limb and patient within the regression model.

Results

Initial technical success was achieved in 401 of 404 procedures. In one limb treated for small saphenous reflux, the guidewire and then the laser probe passed up outside the vein without this being recognised until after the procedure. In two other limbs treated for great saphenous reflux, it was considered that a large vein had not been adequately compressed onto the laser probe to achieve occlusion.

In 21 limbs, recanalisation was detected on surveillance, usually to a minor degree when compared with the initial reflux. This resulted in a primary ultrasound success rate at 3 years by life table analysis of 80% (95% CI, 69%–87%) (Box 1A). Eleven of these limbs were treated by ultrasound-guided sclerotherapy to obliterate the recurrent vein at intervals from 7 to 570 days after EVLT, and this was successful in all but one, resulting in a secondary ultrasound success rate at 3 years by life table analysis of 88% (95%,CI, 78%–95%) (Box 1B).None of the covariates studied were associated with late failures on Cox regression analysis (data available from authors).

Ultrasound detected 14 of 334 limbs (4.2%) treated for great saphenous reflux where reflux later developed into thigh tributaries from the saphenofemoral junction (n = 12) or low abdominal or pelvic veins (n = 2).ComplicationsPatients are warned about vein thickening and tenderness along tributaries treated by ultrasound-guided sclerotherapy after EVLT, and are told that these will completely resolve in time.One patient with very severe right heart failure and high venous pressures causing intermittent bleeding from varices developed severe painful inflammatory swelling along the treated great saphenous vein; this was the only patient in the series who subsequently died, at 18 months from the cardiac disease. Otherwise, all patients had temporary mild pain that was controlled by oral analgesics with no more than moderate bruising along the site.Partial thrombosis of the popliteal vein was detected in two limbs: just above the saphenopopliteal junction after small saphenous EVLT in one limb, and in the distal popliteal vein after ultrasound-guided sclerotherapy for tributaries at 2 weeks after great saphenous EVLT in the other. Serial scans showed that these progressively incorporated into the wall over 3 weeks. Another four limbs developed posterior tibial vein occlusion after ultrasound-guided sclerotherapy for tributaries, and serial scans showed that each recanalised over about 3 weeks. These were all asymptomatic, and were only detected because of routine postoperative scanning. Another patient developed clinical pulmonary embolism (confirmed by computed tomography) at 3 days after EVLT; no deep vein thrombosis was identified and no long-term sequelae occurred. Thus, the incidence of thromboembolic complications in the 308 patients was 2.2%.One patient developed sural nerve palsy after small saphenous EVLT, with partial recovery at 6 months. There were no other nerve injuries or thermal damage.No other significant complications were encountered.

EVLT was performed using the Diomed 810 nm diode system (Diomed, Inc, Andover, Mass, USA). It is not necessary to sedate the patient. Ultrasound guides the various stages using a 12–5 MHz linear array probe for most limbs. The distal end of the saphenous vein to be treated and the saphenofemoral or saphenopopliteal junction are marked. The limb is prepared as for a surgical operation and the operator is gowned and gloved.The ultrasound probe in a sterile sheath shows the vein in a longitudinal view. The puncture site is infiltrated with 1% plain xylocaine, a stab is made to accommodate a sheath, a 19-gauge angiogram needle punctures the vein under vision, a 0.035-inch safety-J guide wire is passed up the vein to the saphenous junction, and a 45-cm-long 5F sheath is passed over the wire to the junction. Ultrasound is used to guide injection of 7–8-mL aliquots of a 0.2% xylocaine with adrenaline solution through a 25-gauge needle into the fascial space surrounding the vein at intervals down its length. The fluid compresses the vein onto the probe and acts as a heat sink for laser energy,protecting adjacent structures as well as providing anaesthesia.

The guidewire and sheath dilator are removed, and a laser probe is passed up the sheath. Markers on the probe allow 2 cm of probe to extend beyond the sheath. Settings are selected to deliver 14 W of power at a continuous rate. The probe tip is placed 2 cm below either saphenous junction and the position of the probe below the junction is confirmed by transillumination. The probe is then activated and withdrawn at about 3 mm/s .

After completion of EVLT, the limb is placed in firm compression bandages and the patient is immediately ambulated. Pain is usually well controlled by oral analgesics, and most patients are able to resume normal activities by the next day.Further treatment by ultrasound-guided sclerotherapy for residual distal veins was required after 80% of procedures, usually performed 1–3 weeks after EVLT, to control tributaries (70%) and the distal saphenous vein (10%). No surgical procedure has been required in any limb.

Varicose vein therapy

Definition

Varicose vein therapy is used to treat enlarged veins (varicose veins) that have problems with their valves.

Alternative Names

Vein stripping; Sclerotherapy of veins; Endovenous ablation therapy

Description

Varicose veins usually occur in the legs. Normally, valves in your veins keep blood flowing. But the valves in varicose veins are either damaged or missing. This causes the veins to remain filled with blood, especially when you are standing.Varicose veins treatments help remove non-moving (stagnant) blood and re-route blood flow through deeper veins in the legs. There are several types of treatment:

Surgical vein stripping: is an outpatient procedure. You receive general anesthesia, which means you are asleep and do not feel pain. The surgeon makes a cut at the bottom (ankle end) and the top (groin end) of the varicose vein. A thin, plastic, tube-like instrument is placed into the vein and tied around it. When the tube is pulled out, it pulls the vein from out under the skin. Small surgical cuts can also be made over individual veins to remove them.
Sclerotherapy: is done while the patient is standing. A solution is injected into each varicose vein to cause clotting, which closes off the vein. An elastic bandage is wrapped snugly around the legs after the procedure.
Endovenous ablation therapy: is an outpatient procedure. The therapy uses heat to destroy vein tissue. A thin catheter (or tube) is inserted into the vein through a tiny skin incision under local anesthesia. Then, using either laser or radiowave (radiofreqency) energy, the vein is heated and cauterized. This closes off the vein.Today, fewer doctors are performing the traditional vein stripping surgery as more patients choose the less invasive endovenous ablation procedure. The endovenous ablation procedure has shown to work the same as or better than surgery. Patients have significantly less pain and a quicker recovery.

Why the Procedure is Performed

Varicose vein therapy may be recommended for:

• Varicose veins that cause circulatory problems (venous insufficiency)
• Leg pain, often described as heavy or tired
• Skin irritation and sores (ulcers)
• Blood clots in the veins (phlebitis), which can travel to the lungs (embolism)
• Cosmetic purposes

Risks

The risks for any anesthesia include:

• Reactions to medications
• Problems breathing

The risks for any surgery include:

• Bleeding
• Infection
• Bruising

Unique risks of endovenous varicose vein surgery include:

• Blood clots (call your doctor if your feet or legs swell)
• Treated vein opens up
• Skin burns from heated catheter

Unique risks to sclerotherapy treatment include:

• Irritation of the vein from the solution
• Blocked blood flow caused by the solution
• Leakage of the solution out of the veins into other tissue (can damage surrounding tissue and form ulcers)

Risks associated with any treatment for varicose veins include:

• Nerve injury
• Return of the varicose veins
• Outlook (Prognosis)
  Most patients who undergo varicose vein surgery have good results. Some patients, however, have inflammation and skin discoloration that last for several months following surgery.Talk to your physician about these risks and your chances for good results.

Recovery

After endovenous ablation therapy and sclerotherapy the patient can almost immediately resume most of their normal activities. Surgical stripping usually requires at least 3 -7 days rest, but you could need up to several weeks.After treatment your legs are wrapped tightly in bandages. Walking is possible the day of surgery. In fact, walking is encouraged to minimize swelling and avoid the risk of deep venous thrombosis, especially with catheter or endovenous treatment.

It is important that feet are kept raised above the heart whenever possible.

Varicose Veins and Venous Insufficiency

Interventional Radiology Nonsurgical Outpatient Procedure Treats Varicose Veins

Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don’t close properly, they allow blood to flow backward, a condition called reflux. Veins that have lost their valve effectiveness, become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in a thigh vein called the great saphenous, which leads to pooling in the visible varicose vein .

Prevalence of Varicose Veins and Venous Insufficiency

Chronic venous disease of the legs is one of the most common conditions affecting people of all races. Approximately half of the U.S. population has venous disease–50 to 55% of women and 40 to 45% of men. Of these, 20 to 25% of the women and 10 to 15% of men will have visible varicose veins. Varicose veins affect 1 out of 2 people age 50 and older, and 15 to 25% of all adults.
Risk Factors

• Age
• Family history
• Female gender
• Pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of varicose veins.

Symptoms

Symptoms caused by venous insufficiency and varicose veins include aching leg pain, easy leg fatigue, and leg heaviness, all of which worsen as the day progresses. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms. In more severe cases, venous insufficiency and reflux can cause skin discoloration and ulceration which may be very difficult to treat. One percent of adults over age 60 have chronic wounds known as ulcers.

People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.

Diagnosis and Assessment

An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging guidance, will use duplex ultrasound to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. The doctor will map the great saphenous vein and examine the deep and superficial venous systems to determine if the veins are open and to pinpoint any reflux. This will help determine if the patient is a candidate for a minimally invasive treatment, known as vein ablation.

Varicose Vein Treatments

Minimally Invasive Vein Ablation Treatment

This minimally-invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh. Then laser or radiofrequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed. Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow

Benefits of Vein Ablation Treatment

• The treatment takes less than an hour and provides immediate relief of symptoms.
• Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
  No scars or stitches – because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.
• High success rate and low recurrence rate compared to surgery.
• The success rate ranges for vein ablation ranges from 93 – 95 percent.

Insurance

Many insurance carriers cover the vein ablation treatment, based on medical necessity for symptom relief.

• Surgical Treatment of Veins,Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures.
• Once the study found a 29% recurrence rate after ligation and stripping of the greater saphenous vein, and a rate of 71% after high ligation. These recurrence rates are similar to those reported in other studies.

Second Opinion

Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.

 

Additional Treatments for Varicose Veins

Ambulatory Phlebectomy

A minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

Injection Sclerotherapy

Can also be used to treat some varicose and nearly all spider veins. An extremely fine needle is used to inject the vein with a solution which shrinks the vein.

Ultrasound-guided Sclerotherapy

Involves an interventional radiologist passing a thin tube called a catheter into the vein using ultrasound guidance and injecting substance that causes the veins to scar and close – rerouting the blood to healthier veins. The affected vein forms a knot of scar tissue that is absorbed by the body over time

Preventing Varicose Veins

How Can Varicose Veins Be Prevented?

Most people can reduce the risk of developing varicose veins, or lessen the severity, by practicing the following behaviors suggested below. The same applies to preventing its reoccurrence following treatment.

Preventing Varicose Veins

Exercise regularly

Take 30-minute or longer walks several times a week or participate in other exercises, such as bicycling or jogging, to strengthen leg muscles and improve blood circulation. Before beginning an exercise program, check with your doctor, especially if you have health conditions such as heart disease, high blood pressure, arthritis, or breathing difficulties.

Avoid standing for long periods

Sit down frequently and elevate your legs. While standing, shift your weight often from one leg to another. Bounce up and down on the tips of your toes several times an hour. Take a walk if you can. After a day that has required many hours of standing, elevate your legs for about an hour

Keep your legs elevated when you sit or lie down

When your legs are off the ground, and raised to at least the level of your heart, the veins in your legs have an easier time moving blood to your heart. Put your feet up when sitting at home, and put a pillow under your feet when you are in bed

Using wooden blocks

Using wooden blocks, raise the foot of your bed about two inches off the floor to help the blood flow back to your heart while you sleep.

Avoid sitting for long periods

If you must sit most of the day at work, take several breaks from sitting throughout the day and take short walks to improve circulation.

Try not cross your legs when you sit

Crossing your legs compresses the veins and can affect blood flow in the leg.

Wear compression stockings

If you are at high risk for varicose veins or already have them, wear compression stockings. Put the stockings on before you get out of bed every morning and wear them all day. Compression hose are available in most pharmacies.

Avoid tight clothing

Clothing that restricts blood flow increases your risk of developing varicose veins.

Don’t wear high heels

 High-heeled shoes make you use the muscles in your buttocks, rather than calf muscles, to walk. Walking in high heels does not promote blood flow in legs. Low-heeled or athletic shoes help strengthen calf muscles and improve circulation.

Keep your weight down

Too much body fat, particularly in midsection, can put pressure on your thighs and groin, weakening the walls and valves of the veins in your legs and groin.

Eat foods high in fiber

A high-fiber diet will help you avoid constipation, a condition that puts pressure on the veins in the anus and increases the risk of hemorrhoids.

Consider taking vitamin C supplements

There is evidence that vitamin C may help strengthen blood vessel walls.

Varicose veins Causes,Risk factors,Lifestyle and home remedies,Alternative medicine

Definition

Varicose veins are gnarled, enlarged veins. The word “varicose” comes from the Latin root “varix,” which means “twisted.” Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins in your lower body.

For many people, varicose veins and spider veins — a common, mild and medically insignificant variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes the condition leads to more serious problems. Varicose veins may also signal a higher risk of other disorders of the circulatory system.

Varicose veins are a common condition in the United States, affecting up to 15 percent of men and up to 25 percent of women. Treatment may involve self-help measures or procedures by your doctor to close or remove veins.

Symptoms

Some people with varicose veins don’t experience any discomfort from the condition. When painful signs and symptoms do occur, they may include:

•  An achy or heavy feeling in your legs
•  Burning, throbbing, muscle cramping and swelling in your lower legs.
• Prolonged sitting or standing tends to make your legs feel worse.
• Itching around one or more of your veins.

Skin ulcers near your ankle, which represent a severe form of vascular disease and require immediate attention. varicose veins are dark purple or blue in color and may appear twisted and bulging — like cords. They commonly appear on the backs of the calves or on the inside of the leg. However, they can form anywhere on your legs, from your groin to your ankle.Spider veins are similar to varicose veins, but they’re smaller. Spider veins are found closer to the skin’s surface and are often red or blue. They occur on the legs, but can also be found on the face. Spider veins vary in size and often look like a spider’s web or a tree branch.

Causes

Arteries carry blood from your heart to the rest of your tissues. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Muscle contractions in your lower legs act as pumps, while toned, elastic vein walls help blood return to your heart. Tiny one-way valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.

As you get older your veins can lose elasticity, causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Blood pools in your veins, and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated.

Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Hemorrhoids are varicose veins located in and around the anus.

Risk factors

These factors increase your risk of developing varicose veins:

Age:

Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to malfunction.

Sex:

Women are more likely than men are to develop the condition. Hormonal changes during pregnancy, premenstruation or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins.
 
Genetics:

If other family members had varicose veins, there’s a greater chance you will too.

Obesity:

Being overweight puts added pressure on your veins. Standing for long periods of time. Your blood doesn’t flow as well if you’re in the same position for long periods.

Lifestyle and home remedies

Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.

Stockings today come in a variety of strengths, styles and colors. With the variety offered, you’re likely to find a stocking that you’re comfortable wearing.You can buy compression stockings at most pharmacies and medical supply stores. Prices vary. Prescription-strength stockings also are available.

When purchasing compression stockings, make sure that they fit properly. Using a tape measure, you or your pharmacist can measure your legs to ensure you get the right size and fit according to the size chart found on the stocking package. Compression stockings should be strong but not necessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult. There are devices to make putting them on easier.

Alternative medicine

Evidence suggests that horse chestnut seed extract may be an effective treatment for chronic venous insufficiency (CVI), a condition associated with varicose veins in which leg veins have problems returning blood to the heart. The herb may help improve swelling and discomfort caused by varicose veins. Talk with your doctor before trying horse chestnut seed extract or any other herb or dietary supplement.

Treatments For Varicose Veins

How can compression stockings help with varicose veins?

Compression stockings work simply by reducing the amount of blood and pressure in the veins. There are various types of stockings available, and some may apply more pressure than others. The main problem with compression stockings is that the blood will return to the veins soon after the stockings are taken off. They also may be uncomfortable for some people, and therefore, they may not worn for long enough to have any benefit.These stockings typically lose their pressure if washed a few times, so they may need to be replaced from time to time.

What is sclerotherapy?

“Sclerotherapy” uses a fine needle to inject a solution directly into the vein. This solution irritates the lining of the vein, causing the vein to swell and the blood to clot. The vein turns into scar tissue that may eventually fade from view. Sclerotherapy is typically used for spider veins and varicose veins that are less than 6 millimeters in length. This is generally offered to patients who have tried compression stockings and leg elevation without much success.Today, the substances most commonly used in the United States for sclerotherapy are hypertonic saline and sodium tetradecyl sulfate (Sotradecol). Aethoxyskerol (Polidocanol) is undergoing FDA testing but has not yet been approved in the U.S. for sclerotherapy. Sclerosing agent or solution is the general term for the substances used for sclerotherapy.In sclerotherapy, after the solution is injected, the vein’s surrounding tissue is generally wrapped in compression bandages for several days, causing the vein walls to stick together. Patients whose legs have been treated are put on walking regimens, which forces the blood to flow into other veins and prevents the development of blood clots. This method and variations of it have been used since the 1920’s. In most cases, more than one treatment session will be required.

What are potential side effects and complications of sclerotherapy?

In about 10-%30% of patients treated with sclerotherapy, dark discoloration of the injected area may occur (hyperpigmentation). This usually happens because of disintegration of the red blood cells in the treated blood vessel. In majority of cases, this discoloration will completely go away within 6 months.
Another problem may be the formation of new spider veins near the area that was treated with sclerotherapy. This can happen in about 20% of patients, but these new vessels also typically disappear within 6 months.
More rare complications may include the formation of an ulcer around the injection site and the formation of small blood clots in the small surface veins (superficial thrombophlebitis).

Is sclerotherapy safe for everyone with varicose and spider veins?

Sclerotherapy is generally safe for most people for treatment of varicose veins and spider veins. However, in certain groups of people, sclerotherapy needs to be avoided, including non-ambulatory people (those unable to walk). Other contraindications for sclerotherapy include obesity, blood clots in the deeper veins, allergy to the sclerosing agent, pregnancy, and arterial obstruction (blocked blood flow in the artery near the varicose vein).

What surgical procedures are available to treat varicose veins?

Varicose veins are frequently treated by eliminating the “bad” veins. This forces the blood to flow through the remaining healthy veins. In vein stripping surgery, the problematic veins are “stripped” out by passing a flexible device through the vein and removing it through an incision near the groin. Smaller tributaries of these veins also are stripped with this device or removed through a series of small incisions. Those veins that connect to the deeper veins are then tied off. This stripping method has been used since the 1950’s.

Spider veins cannot be removed through surgery. Sometimes, they disappear when the larger varicose veins feeding the spider veins are removed. Remaining spider veins also can be treated with sclerotherapy.

Do these procedures hurt?

For all of these procedures, the amount of pain an individual feels will vary, depending on the person’s general tolerance for pain, how extensive the treatments are, which parts of the body are treated, whether complications arise, and other factors. Because surgery is performed under anesthesia, pain is not felt during the procedure. After the anesthesia wears off, there can be some pain at or near the incision(s).

For sclerotherapy, the degree of pain will also depend on the size of the needle used and which solution is injected. Most people find hypertonic saline to be the most painful solution and experience a burning and cramping sensation for several minutes when it is injected. Some doctors mix a mild local anesthetic with the saline solution to minimize the pain.

Can laser be used to treat varicose and spider veins?

Spider veins and small varicose veins can be treated with laser treatment applied from the surface of the skin. The laser applies an intense energy that essentially destroys the small blood vessels in the surface of the skin. Results are variable, and multiple treatments may be necessary to have some benefit. This is generally less invasive than sclerotherapy and vein stripping (no insertion of needles or catheters are required). Possible problems may involve a temporary discoloration of the skin.

Larger varicose veins may be treated with endovenous (inside the vein) catheter ablation or laser surgery. This basically involves inserting a probe (or catheter) into the large vein in the lower leg (saphenous vein) and closing the vein by applying heat generated through laser. This technique has proven to be less painful, and it also has a faster recovery time compared to the vein stripping surgery.

What type of doctors provide treatments for varicose and spider veins?

Doctors providing surgical treatments (stripping and laser ablation) include general and vascular surgeons. Sclerotherapy and laser treatments are often performed by dermatologists. Some general, vascular, and plastic surgeons also perform sclerotherapy treatments. You may want to consult more than one doctor before deciding on a method of treatment. Be sure to ask the doctors about their experience in performing the procedure you want.

What are the side effects of these treatments?

A patient should carefully question the doctor about the safety and side effects for each type of treatment. Thoroughly review any “informed consent” forms your doctor gives you explaining the risks of a procedure.

For surgical removal of veins, the side effects are those for any surgery performed under anesthesia, including nausea, vomiting, and the risk of wound infection. Surgery also results in scarring where small incisions are made and may occasionally cause blood clots.

For sclerotherapy, the side effects can depend on the substance used for the injection. People with allergies may want to be cautious. For example, Sotradecol may cause allergic reactions, which can occasionally be severe. Hypertonic saline solution is unlikely to cause allergic reactions. Either substance may burn the skin (if the needle is not properly inserted) or permanently mark or “stain” the skin. (These brownish marks are caused by the scattering of blood cells throughout the tissue after the vein has been injected and may fade over time). Occasionally, sclerotherapy can lead to blood clots. Laser treatments can cause scarring and changes in the color of the skin.

How long do varicose vein or spider vein treatment results last?

Many factors will affect the rate at which treated varicose veins recur. These include the underlying diagnosis, the method used and its suitability for treating a particular condition, and the skill of the physician. Sometimes the body forms a new vein in place of the one removed by a surgeon. An injected vein that was not completely destroyed by sclerotherapy may reopen, or a new vein may appear in the same location as previous one.

Many studies have found that varicose veins are more likely to recur following sclerotherapy than following surgery. However, no treatment method has been scientifically established as being free from recurrences. For all types of procedures, recurrence rates increase with time. Also, because venous (vein) disease is typically progressive, no treatment can prevent the appearance of new varicose or spider veins in the future.

Is one treatment for varicose veins or spider veins better than the other?

The method you select for treating venous disease should be based on the physician’s diagnosis, the size of the veins to be treated and the patient’s:

• treatment history
• age
• history of allergies
• ability to tolerate surgery and anesthesia, among other factors.

As noted above, small spider veins cannot be surgically removed and can only be treated with sclerotherapy. On the other hand, larger varicose veins may, according to many studies, be more likely to recur if treated with sclerotherapy.

How can varicose vein be prevented?

Prevention of varicose veins may be accomplished by periodic leg elevation, avoidance of prolonged standing, and wearing elastic support hose. Regular exercise and control of weight can also be beneficial. These measures can prevent or slow down the progression of varicose veins.