Understanding Varicose Veins: Diagnosis and Treatment Options

09 Nov Understanding Varicose Veins: Diagnosis and Treatment Options

Diagnosis

The health care provider will perform a physical examination, including examining your legs while standing to detect swelling. The provider may also ask you to describe the pain and aching in your legs.

Tests

Health care providers might recommend a venous Doppler ultrasound of the leg as a method for diagnosing varicose veins. Doppler ultrasound is a noninvasive test that uses sound waves to analyze blood flow in veins by using sound waves. Ultrasounds of the legs can be helpful in detecting blood clots.

A health care provider moves a small hand-held unit (transducer), the size of a bar of soap, against the skin over the area to be examined. It is a transducer which transmits images of the veins in the legs to a monitor, which displays the information.

Treatment

The treatment for varicose veins may consist of self-care measures, compression stockings, and surgery or procedures. Procedures to treat varicose veins are usually performed as an outpatient procedure, meaning you can go home the same day.
When varicose vein treatment is performed solely to improve the appearance of the legs (cosmetic purpose), the cost may not be covered by your insurance company.

Self-care

The use of self-care measures, such as exercising, raising the legs when seated or lying down, or wearing compression stockings, can help relieve the pain of varicose veins and possibly prevent them from getting worse.

Compression stockings

Most people begin by wearing compression stockings all day long to increase blood circulation. Compression stockings stretch over the legs, helping veins and muscles to move blood more efficiently. The amount and type of compression varies according to the brand and type of stockings worn.

There are a variety of compression stockings available at most pharmacies and medical supply stores. A prescription-strength stocking may also be covered by insurance if varicose veins are causing symptoms.

Surgeries or other procedures

It is possible for a health care provider to recommend surgery or other procedures if self-care steps and compression stockings do not help, or if the varicose veins are more severe:

Sclerotherapy:

Health care professionals inject varicose veins with a solution or foam that scars and closes them. A few weeks after treatment, varicose veins should disappear.
It is possible to inject the same vein more than once. Sclerotherapy does not require anesthesia and can be performed in a health care provider’s office.

Laser treatment:

A laser treatment consists of sending strong bursts of light into the vein, which causes the vein to slowly fade and disappear with no need for cutting or needles.
Catheter-based procedures that utilize radiofrequency or laser energy.

The procedure is recommended for the treatment of larger varicose veins. Health care providers insert a thin tube (catheter) into an enlarged vein and heat its tip using either radiofrequency or laser energy. Upon removal of the catheter, the heat destroys the vein by causing it to collapse and close.

High ligation and vein stripping:

This procedure involves the tying off of a vein before it joins a deep vein and then removing the vein through a small incision. The majority of people will undergo this procedure as an outpatient. Blood will continue to flow in the leg even after the vein has been removed, as veins deeper in the leg handle the larger volumes of blood.

Ambulatory phlebectomy (fluh-BEK-tuh-me):

Health care providers remove smaller varicose veins through a series of tiny skin punctures. Only the parts of the leg that are being pricked are numbed during this outpatient procedure. It is generally uncommon for scarring to occur.

Lifestyle and home remedies

Varicose veins can be treated with lifestyle and home remedies such as:

Exercise:

Getting your legs moving is a great way to stimulate blood flow. Your health care provider will be able to provide you with recommendations regarding your level of activity.
Manage weight. Excess weight is removed from the body, which reduces unnecessary pressure on the veins.

Avoid salt:

Keeping your diet low in salt will prevent swelling caused by water retention.

Choose proper footwear:

Avoid high heels. Low-heeled shoes engage the calf muscles more, which improves the circulation in your veins.

Avoid tight clothing:

Make sure to avoid wearing tight clothing around your waist, legs, or groin as these garments may restrict blood flow.

Raise the legs:

Make sure that you take several short breaks throughout the day to raise the legs above the level of the heart to improve blood flow in the legs. As an example, lie on the floor with your legs propped up on three or four pillows.

Spend as little time as possible sitting or standing:

The best way to encourage blood flow is to change your position frequently.

Alternative medicine

A number of alternative therapies claim to be effective treatments for chronic venous insufficiency, although they have not been well studied. The condition is associated with varicose veins in which the leg veins are unable to return blood to the heart. There are a number of alternative therapies available for varicose veins, including:

• Horse chestnut
• Butcher’s broom
• Grape (leaves, sap, seed and fruit)
• Sweet clover

Before trying any herb or dietary supplement, consult your health care provider to ensure the product is safe and will not interfere with your medications.

Preparing for your appointment

You will need to have your bare legs and feet examined by your healthcare provider in order to diagnose varicose veins and determine the best course of treatment.
A physician specializing in vein diseases (phlebologist), a vascular surgeon, or one who treats skin diseases (dermatologist or dermatology surgeon) may recommend that you see a specialist. For the time being, there are some steps that you can take to prepare for your appointment.

What you can do

Make a list of the following:

• Your symptoms, including any symptoms that seem unrelated to varicose veins, as well as when they began
• Personal information, including the presence of varicose veins or spider veins in the family
• Medications, vitamins, and supplements you are taking, including dosages
• Questions you should ask your doctor

Here are some basic questions you should ask your doctor:

• What are the most likely causes of my symptoms?
• Would it be possible for my varicose veins to be caused by another condition?
• Which tests will I need to perform?
• How would you recommend I proceed with my treatment?
• What are the best ways to manage varicose veins in conjunction with other health conditions?
• Should I restrict any activities?
• Can you provide me with any brochures or other printed materials? If so, which websites would you recommend?

Choosing a doctor: what to expect

There are a number of questions your doctor is likely to ask you, including:

• When did you first notice varicose veins?
• Is there any pain in your body? If so, how severe is it?
• What has improved your symptoms, if anything?
• What appears to be aggravating your symptoms?

What can you do in the meantime?

You can begin self-care even before your appointment.

• Make sure you do not stand or sit for an extended period of time.
• When seated, raise your legs.
• It is advisable to avoid uncomfortable footwear as well as tight socks or hosiery.