VEIN DISORDERS CENTER

16311 Ventura Boulevard
Suite 1255
Encino, CA 91436
Phone: (818) 905-5502
Email: drgoren@gorenveincenter.com

Conservative Treatment for

Varicose Veins

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.

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.

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.

Venous ulcer due to varicose veins.

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

Fidgeting is healthy

Walking is even healthier

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!

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What do I do for a skin injury received after Sclerotherapy?

 

            I have seen skin injuries after sclerotherapy but usually, very small ones 2-3 mm in diameter but larger than that should not happen! I do not know what size vein(s) have been injected and where the ”skin burn” is localized, hope not in the ankle area where the healing will be much slower. You must have been possibly injected with a too high concentration and the high volume of the sclerosing agent and also possibly not injected properly into the vein but rater in the skin and tissues along the vein! Occasionally, there are open communications between veins and arteries and the possibility does exist that the sclerosing agent while properly injected in the vein crossed into a small artery and caused severe tissue damage (necrosis) responsible for the damage and thus skin ulceration.

Unfortunately, there is not much one can do as eventually all will heal but it will take a few months. Most probably a scar for life will remind you of the “experience”.

            The injured area should be kept clean and covered with dry gauze to prevent any possibility of infection. If the area is by now clean namely not infected one should discuss with the practitioner the possibility of applying a colloid dressing called Duoderm. Compression stocking the knee is mandatory to prevent swelling which is the biggest enemy of any wound healing. Whenever just possible one should elevate the leg about the level of the heart; this should also reduce swelling by gravitational drainage. Any creams you may want to apply should never cover the ulcerated skin, just beyond its margins. In conclusion, be patient, it will go away but very slowly. How it is in Spanish: “Con paciencia se gana il cielo” or “Heaven is won with patience."