CVI Treatment Options
The treatment of CVI involves both medical and surgical treatments:
Diet and lifestyle:
You should avoid prolonged standing or sitting. People with known CVI should elevate their feet above their thighs when sitting and above their heart when lying down three to four times a day if possible to reduce swelling. Structured exercise such as walking to strengthen calf muscles may improve calf muscle function.
Leg compression is considered by most to be first-line therapy for all stages of CVI and has been found in some studies to improve quality of life. Most patients with swelling can use knee-length prescription gradient compression stockings. These stockings help to reduce the symptoms of varicose veins, prevent leg swelling, and decrease the risk of blood clots. Prescription stockings are more effective than over the counter stockings found on the shelves of supermarkets and drug stores.
Compression should be avoided in people who have poor arterial circulation in their legs or neuropathy. Intermittent compression pumps may be helpful initially in patients with massive swelling prior to fitting of prescription compression stockings. Unfortunately, these devices are expensive, time consuming, and their benefits are not clear. Treatment of venous ulcers may require therapy through a wound care center specializing in the application of medical wraps, topical antibiotics and ointments, exfoliants, and growth factors.
People with CVI and massive swelling may be initially treated with small doses of diuretics for up to a week, with very close monitoring. Diuretics have little benefit if used in large doses or long-term. Topical steroid creams may be used for temporary relief of eczema and dermatitis. Since topical creams may cause contact dermatitis, they should only be used on the advice of a physician. Oral antibiotics may be necessary for those with infection of the legs. This, fortunately, is uncommon.
A variety of herbal supplements for use in patients with CVI are available in health food stores and via the Internet. Herbs and supplements are not strictly regulated by the U.S. Food and Drug Administration. Thus, the strength, purity and safety of these products may vary. The most common herbal supplement found for venous health is horse chestnut seed extract. This extract has been found to reduce swelling and pain associated with CVI in some short-term studies, but the long term benefit is unknown.
Two other herbal supplements, micronized purified flavonoid fraction and French maritime pine bark extract have also been studied for the treatment of CVI. In prospective, randomized studies, only micronized purified flavonoid fraction showed increased healing of venous leg ulcers and reduction of leg swelling. Non-micronized flavonoids have shown no benefits. None of these drugs have FDA approval for use in the U.S. Use of these preparations should be in consultation with your physician.
How are Varicose Veins Treated?
Varicose veins are always a sign of an underlying disorder causing venous insufficiency, whether symptomatic or not. If not treated, symptoms will ultimately develop and the signs and symptoms of venous insufficiency will worsen. Significant advances in the treatment of leg vein problems have occurred in recent years. The treatment of varicose veins may be conservative, minimally invasive, or invasive, depending on the extent of the varicose veins and the specific veins involved. No treatment is without some risks and downsides, and these should be discussed with your health care provider. Prescription compression stockings are almost always the first-line of treatment and should be used prior to or in conjunction with the other therapies. Here are the most common invasive/surgical treatments:
- Sclerotherapy (injections of the veins) involves injecting a sclerosing solution or foam into spider, reticular, or varicose veins. This is a minimally invasive office procedure. Veins that are treated become sealed off, and over time, are eliminated by the body. Typically patients receive multiple treatments and most see significant improvement over the course of several months of treatment.
- Ambulatory phlebectomy is also a minimally invasive procedure that can be performed under local, epidural, or general anesthesia in an outpatient setting. Varicose veins are removed with small hooks through tiny skin incisions. Stitches are not used, and the tiny incisions are pulled together with sterile paper-tape or steri-strips. Recovery is generally brief and uneventful.
- Vein stripping and ligation has been the traditional treatment for bad valves, in the largest the largest surface veins for nearly 100 years. Typically, the great saphenous vein above the knee is stripped (removed), usually through small incision using an atraumatic technique (inversion stripping). Usually only small incisions are required. Stripping is frequently done in conjunction with ambulatory phlebectomy. The entire surgery is safely performed under general, epidural, or local anesthesia and can be performed in an outpatient setting.
- Laser treatments use a fine optical fiber, which is advanced through a catheter into the saphenous vein. Laser energy, in the form of heat, is then delivered through the fiber. As the fiber makes contact with the blood and inner wall of the vein and, as the fiber is slowly withdrawn, the laser energy is absorbed by the blood and vein tissue, sealing it shut. This is a minimally invasive procedure that can be performed in a doctor’s office or outpatient setting with local anesthesia. Recovery is usually fast and uncomplicated.
- Radiofrequency (RF) treatment involves the direct controlled delivery of energy to a vein wall by a small RF probe. This causes collagen in the vein wall to shrink and the vein to close and become sealed off. RF treatment is also a minimally invasive procedure that can be performed in a doctor’s office or outpatient setting. Recovery is typically brief and uneventful.
What You Can Do
You can’t do anything about your heredity, age, or gender. However, you can help delay the development of varicose veins or keep them from progressing.
- Be active. Moving leg muscles keeps the blood flowing.
- Keep your blood pressure under control. Work with your doctor.
- To temporarily relieve symptoms, lie down and raise your legs at least six inches above the level of your heart. Do this for ten minutes a few times each day.
- Strive for a normal weight.
- Wear your prescription compression stockings as specified by your doctor.
- See a qualified doctor who can diagnose the cause of your varicose veins, the sources of venous reflux in your legs, and offer a variety of treatment options.
All of the medical information contained on VDF’s website has been written by medical professionals and then peer-reviewed by a multidisciplinary committee who edits the material appropriately.