WHAT TREATMENTS ARE AVAILABLE AND WHICH IS THE BEST FOR YOU?
1) CONSERVATIVE MEASURES: These include physical measures that improve circulation in the veins. This approach is aimed at alleviating symptoms and slowing the progression of the disease. ALL patients with varicose veins and/or spider veins should be following these guidelines.
During the day:
-Avoid standing still or sitting for long times. try to contract your calf muscle regularly by pointing and flexing your feet.
-Walk 2 times/day for 15 minutes at a minimum. Try to wear compression hose while walking
-Do low impact sports like swimming and biking. Maintain a comfortable breathing pattern while exercising
-Wear compression or support hose regularly. You can get some with out a prescription, higher grades of compression require a prescription
During the night:
-Avoid excess heat on the legs (quilts, electric blankets, etc)
-Keep legs exposed to air as much as possible
During car or plane trips:
-Take frequent breaks to walk or move your legs
-Wear compression hose
-Point and flex your toes to contract calf muscle frequently
-Wear compression maternity hose
-Avoid lifting heavy objects
-Try to limit weight gain to that suggested by your OB-GYN
-Walk, elevate your legs as above
NOTE: For patients with deep venous insufficiency the above measures are very important. In addition, you should wear prescription compression hose all day every day and elevate your legs for 30 minutes every 3-4 hours. Lastly, you should never stand when you could sit, or sit when you could recline.
NOTE: If you ever have bleeding from a leg vein elevate your leg and apply a bandage over the site and apply pressure for at least 5 minutes. If the bleeding does not stop after 10-15 minutes go to an emergency room. It would be rare for this to occur.
Surgery may be needed if you have leaky valves at the major junctions between superficial and deep veins or if you have very large varicose veins. Different types of surgery can be done:
Stripping: This involves an incision over the vein and then putting a long instrument called a stripper inside the vein. The veins internal wall is then stripped away as the stripper is removed permanently damaging the vein. The vein scars and the body will resorb the vein.
This is often not popular with patients because it is a big surgery, leaves scars, and it is not uncommon for the veins to return or for new veins to develop in the treated area. However, it can be very successful for some people.
Short stripping: Similar to above but stripping done only from the groin to the knee. This decreased the number of scars present but sometimes must also do something else for any remaining vein segments is the calf (such as sclerotherapy).
Ligation: This means tying off and cutting the vein. This is often used in combination with stripping. By itself it is rarely successful since veins have a remarkable ability to regenerate even if cut and tied.
3) AMBULATORY PHLEBECTOMY
Removing the varicose vein by making an incision in the skin with a small needle over the vein, then hooking the vein and gently extracting it. This should not be done on varicose veins due to reflux at major junctions of the superficial and deep veins but can be used for most other varicose veins. Small incisions mean minimal scarring. You do have to wear compression wrap and hose afterwards for weeks.
4) LASER THERAPY
With the current technology lasers are only successful on small (<1mm), red spider veins. Lasers work on the premise that light is absorbed by the hemoglobin in the vein and the blood is heated up in the vein. Thermal damage is done to the inside lining of the vein resulting in scarring of the vein.
The amount of energy needed to heat deeper or larger veins is much more than that for spider veins which is why this has not been a good treatment for deeper veins. This increased energy has to pass through the skin and often burns or scars the skin. There are some innovative systems that use hand held devices to cool the skin while using the laser that can help this problem. I still feel if you have any deeper veins feeding the spider veins you should have these treated first with sclerotherapy. I also feel that most spider veins if big enough to get a needle into should be treated with sclerotherapy.
This involves injecting the varicose vein with a sclerosant. A sclerosant is a liquid capable of causing irritation or inflammation to the inner lining to the vein. Like with stripping or laser once this lining is damaged the vein scars and the body will resorb it. This is my preferred way to treat most veins since it is simple and involves little down time.