Conservative

Conservative Treatment for Varicose Veins

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Mr. Schwartz took my advise to elevate his legs to an extreme...

Mr. Schwartz took my advise to elevate his legs to an extreme...

The conservative management of varicose veins consists of two main components: leg elevation and compression.

During the daytime’s upright position the varicose veins protrude/bulge since they are full of blood as the normal uphill (toes to heart) direction of flow has been reversed for a downhill direction of flow. Due to increased venous and subsequently capillary pressure, water could be retained in the tissues causing discomfort and pain as well as ankle swelling.

Elevation, with the help of gravity will restore the normal direction of flow by decongesting the varicosities and lowering the elevated pressure in the venous system. Elevation of the limb is therefore an excellent habit to offset existing symptoms. Indeed, in the evenings, one should watch TV or read with an elevated leg. For better efficiency it is preferable that the elevated foot should be higher than the level of the heart. Unfortunately, it is not a curative modality and not practical during the day for an active, otherwise healthy person.

Compression during daytime in the form of surgical stockings is indeed a more efficient solution. Elastic stocking should be used during daytime and if just possible not intermittently but daily. In the upright position compression lowers the venous pressure by helping the return of blood uphill towards the heart. Nighttime compression is not needed; pressure in the veins is minimal as the horizontal position is enough to decongest the leg veins. A swollen ankle in the evening becomes normal in size by the morning. This effect is known even in people who have no vein problems. Mostly a short, knee level stocking is good enough. Pregnant women who have varicose veins should wear them from day one. During the third and last trimester of pregnancy maternity panty hose is mandatory.

The problem with stocking compression is that compliance is difficult especially during summer months besides being cosmetically undesirable by most women regardless of age.

Similar to leg elevation, this form of conservative management is only supportive and does not cure varicose veins. While they may help with symptoms probably will not stop new veins to pop, but possibly they will slow down additional deterioration. Certainly, if there is a medical contraindication for a definitive procedure stocking represent the only alternative.

Venous ulcer due to varicose veins.

Venous ulcer due to varicose veins.

Same ulcer healed in 6 weeks with the inelastic CircAid legging.

Same ulcer healed in 8 weeks with the inelastic CircAid legging. Patient had surgery that removed her varicose veins and was cured. The pigmentation is for life!

There are other forms of compression such as inelastic (CircAid leggings)  and sequential compressive pumps in form of sleeves (Lymphapress) that are applied on the leg, however, almost never needed for simple uncomplicated varicose veins.

Drugs are also available for the condition that similarly will not make the veins go away although they may be marketed as such. They may reduce the edema of the leg and ease the discomfort by reducing capillary permeability. Buying them makes money circulate and therefore, if not good medically, it is good for the economy. I never advise them, as I do not believe in them. Vitamin K cream is also marketed as useful for varicose veins which is a total nonsense but makes money circulate.

Fidgeting is healthy

Fidgeting is healthy

Walking is even healthier

Walking is even healthier

Standing in place, sitting for prolonged time and being overweight is detrimental. The best is staying active, walking a lot, as this will also lower the pressure and decongest the veins and elevate whenever just possible.

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