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Last updated: 02/17/2009

Alternatives

Conservative treatments

Patients who are experiencing discomfort from varicose veins may be helped by any or several of the following approaches:

  • Exercise. Walking or other forms of exercise that activate the muscles in the...

    lower legs can relieve aching and cramping because these muscles keep the blood moving through the leg veins. One specific exercise that is often recommended is repeated flexing of the ankle joint. Flexing the ankles five to 10 times every few minutes and walking around for one to two minutes every half hour throughout the day helps to prevent the venous congestion that results from sitting or standing in one position for hours at a time.
  • Avoiding high-heeled shoes. Shoes with high heels do not allow the ankle to flex fully when the patient is walking. This limitation of the range of motion of the ankle joint makes it more difficult for the leg muscles to contract and force venous blood upwards toward the heart.
  • Elevating the legs for 15–30 minutes once or twice a day. This change of position is frequently recommended for reducing edema of the feet and ankles.
  • Wearing compression hosiery. Compression benefits the leg veins by reducing inflammation as well as improving venous outflow. Most manufacturers of medical compression stockings now sell some relatively sheer hosiery that looks attractive in addition to providing support.
  • Medications. Drugs that have been used to treat the discomfort associated with varicose veins include nonsteroidal anti-inflammatory drugs (NSAIDs) and preparations of vitamins C and E. One prescription medication that is sometimes given to treat circulatory problems in the legs and feet is pentoxifylline, which improves blood flow in the smaller capillaries. Pentoxifylline is sold under the brand name Trendar®.

If appearance is the patient's primary concern, varicose veins can be partially covered with specially formulated cosmetics that come in a wide variety of skin tones. Some of these preparations are available in waterproof formulations for use during swimming and other athletic activities.


Endovenous ablation

Endovenous ablation refers to two newer and less invasive methods for treating incompetent saphenous veins. In the Closure(R) method, which was approved by the Food and Drug Administration (FDA) in 1999, the surgeon passes a catheter into the lumen of the saphenous vein. The catheter is connected to a radiofrequency generator and delivers heat energy to the vein through an electrode in its tip. As the tissues in the wall of the vein are heated, they shrink and coagulate, closing and sealing the vein. Radiofrequency ablation of the saphenous vein has been demonstrated to be safe and at least as effective as surgical stripping of the vein; in addition, patients can return to work the next day. Its chief risk is loss of feeling in a patch of skin about the size of a quarter above the knee. This numbness usually resolves in about six months.

Endovenous laser treatment, or EVLT, uses a laser instead of a catheter with an electrode to heat the tissues in the wall of an incompetent vein in order to close the vein. Although EVLT appears to be as safe and effective as radiofrequency ablation, patients experience more discomfort and bruising afterward; most require two to three days of recovery at home after laser treatment.


Sclerotherapy

Sclerotherapy is a treatment method in which irritating chemicals in liquid or foam form are injected into spider veins or smaller reticular varicosities to close them off. The chemicals cause the vein to become inflamed, and leads to the formation of fibrous tissue and closing of the lumen, or central channel of the vein. Sclerotherapy is sometimes used in combination with other techniques to treat larger varicose veins.


Complementary and alternative (CAM) treatments

According to Dr. Kenneth Pelletier, former director of the program in complementary and alternative treatments at Stanford University School of Medicine, horse chestnut extract works as well as compression stockings when used as a conservative treatment for varicose veins. Horse chestnut (Aesculus hippocastanum) preparations have been used in Europe for some years to treat circulatory problems in the legs; most recent research has been carried out in Great Britain and Germany. The usual dosage is 75 mg twice a day, at meals. The most common side effect of oral preparations of horse chestnut is occasional indigestion in some patients.


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Other Information

Vein ligation and stripping is a minor surgery. It is used to remove a damaged vein and prevent complications of vein damage. If several valves in a vein and the vein itself are heavily damaged, the vein (or the diseased part of the vein) is removed (stripped). An incision is made below the vein, a flexible instrument is threaded up the vein to the first incision, and the vein is grasped and removed.

During this surgery, one or more incisions are made over the damaged veins, and the vein is tied off (ligated). If the ligation cuts off a faulty valve and the vein and valves below the faulty valve are healthy, the vein may be left in place to continue circulating blood through other veins that still have valves that work well.


From http://www.webmd.com/a-to-z-guides/vein-ligation-and-stripping

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