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What treatments are there for varicose veins?

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Video Overview

The treatment of varicose veins really starts with the proper evaluation. So this consists of a good and targeted history and physical, relevant to vein disease, complimented by duplex ultrasound or sonogram. When you have varicose veins on the surface of the skin, almost always there will be veins below the skin that are feeding into, and contributing or causing, the veins that are visible on the surface. So we must do that proper evaluation to understand what that particular person's pattern of vein disease is. Once we know the pattern, we can design a treatment plan developed for that particular case.

What are the different treatments? One would be conservative treatment. This consists of things like compression stockings and Aerobic activity, avoidance of prolonged standing. That may help improve symptoms, it won't really get rid of the veins but may help slow down worsening of veins which would be a common issue.

Then we have treatment of the veins on the surface of the skin, and generally there are two techniques that we would use for varicose veins though, the dilated bulging veins visible on the surface of the skin. That would be sclerotherapy, which is injection of the medication designed to try and cause those veins to shrink, collapse, and disintegrate. Or in some cases, particularly with larger vein, ambulatory phlebectomy which is a method of removal of the veins but done in office in a very minimally invasive way under local anesthesia with needle punctures rather than incisions, such as one that does not need surgery.

Then we have treatment of the underlying veins that might be feeding into and causing the surface veins. Generally the treatment is either going to be endovenous thermal ablation which could be laser or radio frequency, again designed to get that underlying vein to close off, shrink, and disintegrate. This would be an alternative to vein stripping which would be surgical and requires general anesthesia. The other alternative would be called endovenous chemical ablation, which is where we would, with ultra sound guidance, image the underlying veins and then use foam sclerosis and make injections with the same goal, to close that vein, get it to shrink, and disintegrate.

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