Varicose Veins: Treatments and Therapy
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What Is Varicose Veins: Treatments and Therapy

Varicose veins require   adequate care and therapy, above all to prevent painful and disabling complications (varicophlebitis,  dermatitis , varicose ulcer ). Above all, it is important to implement a preventive criterion: prevention of painful and disabling complications for the patient and prevention of his social marginalization.

However, unfortunately, there is no real cure that is able to permanently solve the problem of varicose veins . Despite this, the treatments available today can relieve most of the symptoms caused by varicose disease

Treatments And Therapy

To deal with the problem of varicose veins, different types of treatments are available which are divided into:

  •  Conservative treatments , among which we find elastic compression and pharmacological therapy.
  •  Minimally invasive ablative treatments , such as sclerotherapy , or endovascular laser or radiofrequency procedures.
  •  Invasive treatments  that involve real surgical interventions, both conservative and removal.

These treatments can be performed individually, or in combination.
In any case, in the case of varicose veins, in most cases, the treatment involves the integration of different therapeutic approaches, which is associated with the adoption of particular hygiene and behavioral rules.

Hygiene And Behavioral Standards

Unfortunately, there is no possibility of conducting  primary prevention  capable of preventing the onset of varicose veins, since the factors responsible for the disease are not yet known precisely. On the other hand, it is possible to exercise a valid preventive action on the factors that can favor the appearance or aggravate varicose manifestations: these are the environmental and working conditions that imply an upright position (venous hypertension), almost immobile (deficit of the muscle pump) , prolonged , in hot environments ( vasodilation ).
Therefore, it can be very useful:

  • Avoid standing or sitting for too long periods of time;
  • Avoid exposing your legs directly to heat sources;
  • Take a walk of at least 20-30 minutes every day;
  • Perform regular  physical activity ;
  • Sleeping with the lower limbs raised above the rest of the body.

Other times, in the appearance of varicose veins, being overweight (obesity, pregnancy) is decisive, hence the importance of following a healthy diet rich in  fruit and vegetables .
On the other hand, the role of other factors such as the constant intake of oral contraceptives is very doubtful .

Medicines

Pharmacological therapy   is based on the use of “phlebotonic” substances (i.e. substances which increase the tone of the venous wall in order to reduce its exhaustion), anti-edema substances (which reduce edema ) , pro- fibrinolytics  (which prevent the formation of  thrombi  due blood stasis ) and anti-inflammatories. However, there is no serious documentation on whether drugs are able to intervene on the causes of the appearance of varicose veins. Nonetheless, they are not entirely useless because they perform a valid action on the symptoms, reduce the sense of heaviness and evening edema.

Elastic Compression

Elastic compression is   based on the use of  graduated elastic stockings which exert a decreasing compression from the foot towards the thigh (the decreasing trend causes the greater ankle compression to push the blood upwards, encountering resistance as it rises less and less).

Alternatively, elastic bandages can be used, with different types of mesh and with different levels of elastic force . The level of compression to be exercised is in relation to the severity of the varicose disease and must be able to bring venous hypertension back to normal limits.

In any case, elastic contention, at any level of compression, cannot make varicose manifestations regress, but it certainly eliminates the disturbances and prevents complications; if these already exist to some extent they are eliminated. It should be kept in mind that there are some situations of intolerance to compression, such as in the case of arthrosis for example, for which these supports are unacceptable.

Endovascular Treatments

Endovascular treatments are minimally invasive procedures that use laser or radiofrequency technologies to eliminate varicose veins.

These treatments are performed under local anesthesia and under ultrasound guidance and their aim is to eliminate the varicose vein through the heat generated by the laser or radiofrequency.

Compared to classic surgical interventions, endovascular procedures allow you to resume normal daily activities in a very short time, leave no scars and cause less pain in the post-operative phase.

Sclerotherapy

Read more: Sclerotherapy

Sclerotherapy  consists in the injection of chemical substances into the vein which first determine the formation of a  thrombus , then the fibrous transformation of the vein wall. It finds its main application in the field of smaller varicose veins, such as reticular varicose veins and telangiectasias  , but in the presence of truncular varices with involvement of the Greater and Lesser  Saphenous veins , sclerotherapy is doomed to failure and  surgery  represents the cure elective and with the best clinical result at a distance. 

Phlebectomy

Phlebectomy is a surgical procedure that is usually performed under local anesthesia. It consists in the removal of the venous tract affected by the varix and in the reunification of the portions upstream and downstream of the removal.

However, where possible, we try to limit the use of this type of surgical treatment, preferring less invasive approaches, such as conservative therapies, endovascular treatment or sclerotherapy.

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