Compression stockings, which always sounded like such a nice harmless intervention to suggest in minor cases, are now no longer recommended as a first-line intervention unless other interventions are not suitable (pregnancy being a good example). First-line treatment, where treatment is needed, is now endothermal ablation (usually via radiofrequency or laser ablation). If this is unsuitable, the next choice is ultrasound-guided foam sclerotherapy, and the next after that is truncal vein stripping surgery.
Indications for treatment include:
- Troublesome symptoms (pain, swelling, heaviness, itching)
- Lower limb skin changes associated with chronic venous insufficiency (varicose eczema, pigmentation)
- Superficial venous thrombosis (hard, painful veins) with suspected venous incompetence
- History of venous leg ulcers
- Bleeding varicose veins (urgent referral)
Pregnancy is a contraindication to intervention, other than in exceptional circumstances.
Conservative management includes weight loss, light to moderate physical activity, avoiding exacerbating factors for symptoms, and explanation of what causes the veins and what complications may arise.