Varicose Veins

Compression stockings (MOST EFFECTIVE conservative treatment): knee-high or thigh-high graduated compression 20-30 mmHg (medical-grade—over-counter compression socks insufficient), wear daily (put on before standing in morning, remove at night), improves symptoms 60-80% (reduces pain, swelling, heaviness, prevents progression), prevents complications (venous ulcers), lifelong use recommended (vein disease doesn't cure, compression manages symptoms), expensive but insurance often covers with prescription, measure properly (wrong size ineffective or uncomfortable), Exercise: walking, swimming, cycling (calf muscle pump returns blood to heart, improves circulation), calf raises (strengthen calf muscles), avoid prolonged standing or sitting (move every 30-60 minutes), Elevate legs: above heart level for 15-30 minutes 2-3x/day (reduces venous pressure, decreases swelling), sleep with legs elevated (pillow under feet), Avoid: prolonged standing or sitting (move frequently), crossing legs (restricts circulation), tight clothing around waist or legs (restricts venous return), high heels (calf muscle pump less effective—wear low heels or flats), hot baths, saunas (dilate veins, worsen symptoms), Weight loss if overweight (reduces venous pressure, improves symptoms), Skin care: moisturize legs (prevent dryness, cracking—venous insufficiency causes skin changes), protect from injury (heals slowly, can lead to ulcers), watch for skin changes (discoloration, thickening, ulcers—signs of advanced venous insufficiency, need treatment), Medical treatments: Sclerotherapy (inject solution into vein—irritates lining, vein collapses and is reabsorbed, 60-80% success, multiple sessions often needed, treats small-medium varicose veins and spider veins, outpatient, minimal downtime, complications—hyperpigmentation, matting—new tiny spider veins, rare serious—DVT, allergic reaction, skin ulceration), Endovenous Ablation (radiofrequency or laser—heat destroys vein from inside, vein seals shut and is reabsorbed, 90-95% success at 5 years, treats large varicose veins, minimally invasive, local anesthesia, outpatient, faster recovery than vein stripping, complications—bruising, numbness, rare serious—DVT, nerve injury, skin burns), VenaSeal (medical glue injected to seal vein—newer technique, no heat or sclerosant, less bruising, no compression stockings after, expensive, long-term data limited), Ambulatory Phlebectomy (tiny incisions to remove varicose veins—for bulging surface veins, local anesthesia, outpatient, minimal scarring), Vein Stripping (surgical removal of varicose vein through incisions—older technique, effective but more invasive, general or spinal anesthesia, longer recovery 2-4 weeks, more complications than newer techniques, rarely needed now—endovenous ablation preferred), Indications for procedures: cosmetic concerns (patient desires treatment, not medically necessary), symptomatic (pain, heaviness, swelling, nighttime cramps interfering with quality of life despite conservative treatment), complications (bleeding, superficial thrombophlebitis, venous ulcers), Conservative treatment tried first: compression stockings, weight loss, exercise, elevation, supplements for 3-6 months—if insufficient improvement, consider procedures, Varicose veins often recur: new veins develop over time (genetic predisposition, ongoing venous insufficiency), treated veins don't recur but new ones can form, compression stockings, weight loss, exercise reduce recurrence, may need repeat treatments.