Venous insufficiency

Leg elevation

May be overrated as a treatment for aching legs – it tends to be uncomfortable and there’s no real evidence as to effectiveness. Worth trying in rest periods for patients who stand a lot and suffer from aching legs (see below).

Compression stockings

Although these aren’t a good substitute for varicose vein ablation, they can be good for symptoms in the absence of varicose veins. They can also be symptomatically useful in patients who are awaiting varicose vein treatment, or pregnant women with varicose veins. Use the prescribed ones (OTC provide less compression) and use Grade II, although a patient who is having difficulty getting them on could start with Grade I. Use the below-knee. CHECK PEDAL PULSES FIRST as they should not be used if significant peripheral arterial disease present.

Other conservative measures

If a lot of time is spent on the feet, increasing rest periods is likely to be the most helpful option, with leg elevation during resting. Weight loss may be helpful. It’s not known whether exercise is or not, but worth trying. Circulation boosting footplates/other neuromuscular electrical stimulation devices seem to be helpful in some cases but there’s no real evidence for them long-term. Horse chestnut seed extract may help but the evidence is not strong.

Varicose vein treatment

Underrated, and should be used more. NICE recommends referral to vascular service in case of:

  • Symptomatic veins
  • Thrombophlebitis
  • Venous eczema
  • Venous leg ulcers (shown to make marked difference in recurrence rates – 50% recurrence without varicose vein removal, 25% with – and also to help healing of prolonged ulcers).

Varicose vein treatment has also been shown to be helpful for patients with restless legs.

Endothermal ablation is now the recommended treatment; it takes 20 – 30 minutes, is well tolerated, and success rates are reported at >90% at one year. Ultrasound-guided foam sclerotherapy is also effective though may be less so.

(From Pulse Learning module)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Varicose veins, Vascular. Bookmark the permalink.

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