The following is excerpted from the NIH’s excellent page describing how varicose veins are treated.

Medical Procedures
Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn’t cause problems with blood flow because the blood starts moving through other veins.

You may be treated with one or more of the procedures listed below. Common side effects right after most of these procedures include bruising, swelling, skin discoloration, and slight pain.

The side effects are most severe with vein stripping and ligation (li-GA-shun). Although rare, this procedure can cause severe pain, infection, blood clots, and scarring.

Sclerotherapy
Sclerotherapy (SKLER-o-ther-a-pe) uses a liquid chemical to close off a varicose vein. The chemical is injected into the vein to cause irritation and scarring inside the vein. The irritation and scarring cause the vein to close off, and it fades away.

This procedure often is used to treat smaller varicose veins and spider veins. It can be done in your doctor’s office, while you stand. You may need several treatments to completely close off a vein.

Treatments are typically done every 4 to 6 weeks. Following treatments, your legs will be wrapped in elastic bandaging to help healing and decrease swelling.

Microsclerotherapy
Microsclerotherapy (MI-kro-SKLER-o-ther-a-pe) is used to treat spider veins and other very small varicose veins.

A small amount of liquid chemical is injected into a vein using a very fine needle. The chemical scars the inner lining of the vein, causing it to close off.

Laser Surgery
This procedure applies light energy from a laser onto a varicose vein. The laser light makes the vein fade away.

Laser surgery is mostly used to treat smaller varicose veins. No cutting or injection of chemicals is involved.

Endovenous Ablation Therapy
Endovenous ablation (ab-LA-shun) therapy uses lasers or radiowaves to create heat to close off a varicose vein.

Your doctor makes a tiny cut in your skin near the varicose vein. He or she then inserts a small tube called a catheter into the vein. A device at the tip of the tube heats up the inside of the vein and closes it off.

You will be awake during this procedure, but your doctor will numb the area around the vein. You usually can go home the same day as the procedure.

Endoscopic Vein Surgery
For endoscopic (en-do-SKOP-ik) vein surgery, your doctor will make a small cut in your skin near a varicose vein. He or she then uses a tiny camera at the end of a thin tube to move through the vein. A surgical device at the end of the camera is used to close the vein.

Endoscopic vein surgery usually is used only in severe cases when varicose veins are causing skin ulcers. After the procedure, you usually can return to your normal activities within a few weeks.

Ambulatory Phlebectomy
For ambulatory phlebectomy (fle-BEK-to-me), your doctor will make small cuts in your skin to remove small varicose veins. This procedure usually is done to remove the varicose veins closest to the surface of your skin.

You will be awake during the procedure, but your doctor will numb the area around the vein. Usually, you can go home the same day that the procedure is done.

Vein Stripping and Ligation
Vein stripping and ligation typically is done only for severe cases of varicose veins. The procedure involves tying shut and removing the veins through small cuts in your skin.

You will be given medicine to temporarily put you to sleep so you don’t feel any pain during the procedure.

Vein stripping and ligation usually is done as an outpatient procedure. The recovery time from the procedure is about 1 to 4 weeks.

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I thought this was an interesting article:

If you have varicose veins, special support stockings may ease some of your symptoms, such as aching legs.

There are two types of support stockings for varicose veins.

* If you have varicose veins in your lower leg, you can wear short stockings that cover your leg from your ankle to your knee.
* If your varicose veins are in your upper leg (along the front of your thigh for instance), you can wear the longer type of stockings. These cover your whole leg. Some have open toes and some have closed toes.

All support stockings for varicose veins are tighter at the ankle than at the top. This means they apply more pressure at the bottom of your leg, which helps to squeeze blood upwards towards your heart.

Here are some tips on using support stockings for varicose veins.

* Support stockings come in different sizes, and some are more elastic than others. Larger, more uncomfortable veins need tighter stockings. Your doctor or pharmacist can help you get the right size and fit.
* It’s best to put the stockings on in the morning before you get out of bed. This is because your varicose veins are least likely to be full of blood and swollen after you’ve been lying down. As soon as you stand up, the blood pools in these veins. This makes it harder for the stockings to keep your veins from bulging.
* The stockings gradually get less elastic the more you wash them, so you’ll need to get new ones every few months.

Some people find that their legs feel better if they wear support stockings and look better when they take them off. However, there is no good-quality research to show that stockings help with symptoms or improve the way your legs look.

Source:

http://www.guardian.co.uk/lifeandstyle/besttreatments/varicose-veins-things-to-know-about-support-stockings

Ellis H, Taylor P. Elastic stockings. Greenwich Medical Media. 1999; 50-51.
© BMJ Publishing Group Limited (“BMJ Group”) 2009

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Varicose veins — unsightly bulging veins in the legs — force many embarrassed sufferers to cover up, even on the hottest summer days. While often dismissed as a cosmetic issue, varicose veins actually can develop into serious health problems. According to a new survey, many who suffer from varicose veins aren’t aware of this and are not seeking treatment for their condition. The survey, sponsored by Vein Clinics of America, found that one in five people reported having varicose veins, and half (48 percent) also experienced aching pain in the legs. Surprisingly, most people (87 percent) reported they have never sought treatment and nearly half (42 percent) do not consider varicose veins to be a serious health issue.
“Many people don’t make the connection between varicose veins and leg discomfort, when in fact, varicose veins may be the outward symptom of an underlying problem that could potentially lead to serious health complications,” said Ted King, M.D., Medical Director of the Vein Clinics of America network. “Severe varicose veins put people at risk for a number of conditions, from leg ulcers, bleeding, and phlebitis to blood clots which can be life-threatening, thus treatment can be critical.”
Varicose veins, or twisted, enlarged veins near the surface of the skin, are most commonly seen in the legs and ankles. Varicose veins occur when veins have trouble carrying blood from the legs back to the heart due to faulty valves and weakened vein walls. Many people with varicose veins also experience pain, swelling, numbness, and fatigue in the legs. Varicose veins and related leg symptoms can have an impact on daily life, especially for people with occupations requiring long periods of standing or walking.
“Varicose veins and leg pain are thought to be a normal part of aging, but people shouldn’t have a compromised lifestyle because of it,” said Dr. King. “Today there are safe, effective and minimally invasive treatment options with short recovery time that won’t keep people sidelined from their daily
routine.”
Newer treatments that are less invasive and have largely replaced traditional surgical treatments include:
— COMPASS(SM) protocol of Ultrasound-Guided Sclerotherapy: An advanced form of sclerotherapy, where a foam solution is directly injected into the varicose vein, causing it to close off. The physician visually monitors the vein and injection on an ultrasound screen, allowing considerable control over the area of the venous system being treated. This procedure is used primarily to treat larger varicose veins. A typical treatment takes approximately 15 to 20 minutes and will consist of multiple injections.
— Endovenous Laser Treatment (ELT): A minimally invasive procedure that uses heat from a guided laser to close varicose veins. A small optic fiber is inserted through a needle into the varicose vein under ultrasound guidance. The laser is then activated and as the optic fiber is removed from the vein it heats and closes the vein. This procedure does not require hospitalization or complicated surgery and typically takes less than an hour.

Survey: Plagues of the Legs
Following are highlights of the survey findings:

— One in five Americans (20 percent) report that they have varicose veins.
— Nearly all those surveyed with varicose veins (87 percent) report that they have never sought treatment for their varicose veins.
— Nearly half of those who have varicose veins (42 percent) reported that varicose veins may be unpleasant but they don’t have real health risks.
— Women were significantly more likely to report that they have varicose veins than men (27 percent vs. 10 percent).
— Nearly half of those with varicose veins were ages 35 and older (46 percent).
The national StrategyOne Omnibus surveyed 1,006 people 18 and older. The purpose of the survey was to determine the prevalence of varicose veins and related leg pain/discomfort, measure awareness about the severity of varicose
veins, and determine how many seek treatment. Interviews were conducted via telephone from June 13-16, 2008 using the field services of Opinion Research Corporation (ORC), which uses methodology including random digit dialing and computer-assisted telephone interviewing.

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Varicose and spider veins are a serious subject. But let’s take a break. Here are some interesting facts about vein disease, vein treatments, varicose and spider veins. Enjoy it.

Animals and Varicose Veins
Do Giraffes get varicose veins?
NASA scientists have studied giraffes extensively in an effort to design the ideal gravity suit for astronauts. The determining factor for the pressure in leg veins is the vertical distance between the heart and the legs, which makes the giraffe’s leg vein pressures by far the highest in the animal kingdom. The giraffe, therefore, should be a slam-dunk candidate for varicose veins and swollen legs. It turns out, however, that the skin in the giraffe’s leg is extremely tough and fibrous, and, contrary to other animals (notably humans), the arteries and veins are concentrated exclusively in the center of the leg. It’s as if giraffes wear permanent support stockings.

Here’s More about animals and varicose veins
There are many other reasons why some people develop vein problems and others don’t. Did you know animals don’t develop varicose veins? Most animals stand on four legs. The amount of pressure on their leg veins is much less. There is a shorter distance between their legs and their heart. Hence, in one way they are more fortunate then us because they have minimal vein problems.

Vacular Disease and Varicose Veins
Vein problems are the stepchild of vascular disease. Arteries get all the attention – after all, our brain, heart, kidneys, and all other organs depend on a continuous flow of fresh oxygen. Veins somehow don’t seem as important (unless, of course, you have the problem). Veins are actually more complicated than arteries because they are more difficult to understand and definitely more difficult to operate on. And that challenge may be why I am continually fascinated with them. The following very limited selection of vein trivia and oddities may be of some interest.

In 86 BC, Caius Marius, a Roman general and later tyrant, had the first recorded operation for varicose veins.

Here’s how Plutarch, the great biographer of Greek and Roman times, describes the event:
Marius is praised for both temperance and endurance, of which latter he gave a decided instance in an operation of surgery. For having as it seems, both his legs full of great tumors, and disliking the deformity, he decided to put himself into the hands of an operator. When, without being tied, he stretched one of his legs, and silently, without changing countenance, endured most excessive torments in the cutting, never either flinching or complaining; but when the surgeon went to the other, he declined to have it done, saying “I see the cure is not worth the pain.”
Wise Marius! With today’s local anesthesia techniques, even the largest varicose veins can be removed without the need for general anesthesia or even intravenous sedation. All procedures at Triangle Surgery Center are done as an outpatient, with patients returning to full activities in short order. Even Caius Marius could have returned to his legion posthaste.

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Varicose Veins – You Can and Should Use Home Treatments
Most doctors will suggest that a large number of people suffering from varicose veins which are not causing serious problems follow a regimen of various home treatments. These are varicose vein treatments you can do at home can often relieve symptoms. They can also reduce the progression of varicose vein disease.

Varicose Vein Treatments designed for home. :
• Elevate your legs. Prop up your legs at or above the level of your heart when possible.
• Don’t sit or stand for long periods of time. This can stress veins in your legs. Mix your activities
• Exercise and control your weight. Walk, bicycle, or swim to improve blood circulation in your legs.
• Wear compression stockings. Compression stockings improve circulation and are the mainstay of treatment for varicose veins.
• Avoid situations – superficial varicose veins will often cause bruising or bleeding when your skin is cut or it is scratch the skin over a larger vein. Small blood clots may occasionally form in the surface veins (superficial phlebitis). Most of these problems can be safely treated at home.
• If you bump your leg so hard that you know it is likely to bruise, elevate your leg and apply ice or a cold pack as soon as you can for the next hour or two. This may help reduce the amount of bleeding under the skin and minimize bruising.
• If you cut or scratch the skin over a vein, it may bleed a lot. Elevate your leg and apply firm pressure with a clean bandage over the site of the bleeding. Continue to apply pressure for a full 15 minutes. Do not check to see if the bleeding has stopped sooner. If the bleeding hasn’t stopped after 15 minutes, apply pressure again for another 15 minutes. You can repeat this up to three times for a total of 45 minutes.

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This information explains varicose and spider vein treatments in the United Kingdom. This article is excerpted with credit at the end of this article.
Varicose Vein Treatment benefits and risks described in this article are based on research studies. Before drawing any conclusion about varicose or spider vein treatment, consult your physician.

Surgery to remove varicose veins?
An operation can remove varicose veins in your legs. Varicose veins don’t usually cause serious health problems, but they can be uncomfortable, and many people don’t like the way they look.
You get varicose veins when the valves in your veins don’t close properly. Valves let blood flow in only one direction through your blood vessels. But if the valves don’t close, blood can trickle backwards and pool in your veins. This causes the bulging, twisted veins that you can see through your skin. In the operation to remove varicose veins, your surgeon will make a cut in your leg and remove the vein with the faulty valves.
The faulty valves are usually found in one of the two large veins that run just under the skin along the length of your leg. These are called surface veins. One surface vein runs up your inside leg from your ankle to your groin. The other runs up the back of your leg from your ankle to your knee.

Varicose Veins – Why do I need surgery to remove varicose veins?
Doctors usually remove varicose veins to:
• Improve the way your legs look
• Help with symptoms such as swollen, achy legs
• Treat problems such as bleeding or open sores (ulcers).
Each year, about 50,000 people in England and Wales have surgery to remove varicose veins. But not everyone is able to have their varicose veins removed on the NHS. Guidelines from the National Institute for Health and Clinical Excellence (NICE), the government body that advises doctors about treatments, says that people whose varicose veins bleed or cause ulcers should be the top priority.
What happens during surgery to remove varicose veins?
The operation usually takes between one hour and two hours. You should be able to go home the same day. If you have varicose veins in both legs, it’s usual to have two separate operations on different days.
Preparing for the operation
You will probably have tests, such as an ultrasound, to find out which valves are faulty. You will also need to stand up for a while so your doctor can see where blood is pooling in your veins. Your varicose veins will be marked with a pen because the bulges are harder to see when you’re lying down for surgery. You may have to shave your legs.
If you have a general anaesthetic, you won’t be able to eat anything for eight hours before the operation or drink anything for up to two hours before.

The operation
Surgeons can remove varicose veins in several different ways. You can talk to your surgeon about how they plan to do your operation.
The most common operation involves tying off and pulling out the main surface vein that runs up the inside of your leg. Doctors call this ligation and stripping.
Surgeons usually remove only the section of vein between the groin and knee. Less often, the whole vein is taken out from the groin to the ankle.

• Your surgeon makes two cuts: a 5-centimetre (two-inch) cut along the crease in your groin, and a 1-centimetre (half-inch) cut lower down your leg, usually on the inside of your knee. If you’re having the whole vein removed, the lower cut is made at the ankle.
• Your surgeon then looks inside your groin and finds the top of the main surface vein in your leg. This vein is tied off at the top (and sometimes at the lower end) to stop blood flowing through it. This is called ligation.
• A thin, bendy wire is then passed down through the vein to the lower cut. There’s a stripping tool at the upper end of the wire.
• Your surgeon pulls the wire out through the lower cut. The vein and its branches bunch up on the stripping tool and are pulled out from the knee or ankle. This is called stripping.
• Sometimes, instead of pulling out the vein through a cut lower down your leg, the surgeon makes only one cut at the top of your leg and removes the vein through this top cut. This is called inversion stripping. Surgeons use a special instrument to pull the vein out. As the vein comes out it turns inside out (inverts). Because there is only one cut with this operation, it should be less painful than standard stripping. And you should recover more quickly.
• The surgeon then sews up the groin and the lower cut using stitches that will dissolve.
• The surgeon will probably also make lots of tiny cuts (about 5 millimetres, or a fifth of an inch long) down your leg and use a hook to pull out smaller bits of bulging vein. This is called avulsion or phlebectomy. The cuts don’t need stitches, but the surgeon may seal them using paper strips.
• Surgeons can use an electric device that sucks small bits of vein out of your leg. The surgeon uses a light, which goes under your skin to see the veins that need to be removed. This operation is called transilluminated powered phlebectomy. It’s sometimes used instead of pulling out varicose veins with a hook because it needs fewer cuts. NICE says that there hasn’t been enough research to say how safe this technique is or how well it works. If your doctor want to do this operation, they should make sure you understand what is involved. You also need to know that doctors still aren’t certain how safe this operation is. You should only agree to have transilluminated powered phlebectomy after you have discussed these things with your doctor.
• Your whole leg is bandaged at the end of the operation.
Varicose veins in your lower leg can be removed in a similar operation. The main vein is tied off and removed through a small cut made on the back of your knee. Varicose veins can also be tied off instead of pulled out. They are left in your leg, but don’t bulge because blood can’t flow through them.
Having a vein taken out or tied off won’t affect the circulation of blood in your body. Blood will flow through other veins instead.

Will it be painful?
You shouldn’t feel any pain while your varicose veins are being removed. Your groin and leg will be sore afterwards, but you will be given painkillers to help. If your painkillers don’t work, you should tell the nurse, who will be able to give you a higher dose or a different type of painkiller.

How can surgery for varicose veins help me?
There isn’t much good research on how well surgery for varicose veins works. However, after your operation, it’s likely that:
• Your legs will look better.
• Symptoms such as aching or tired legs will improve.
• You’ll enjoy life more.
Most people say they feel happier after surgery. In one study of 100 people, nearly 9 in 10 said their legs were much better or cured a few months after their operation. After 10 years, two-thirds of these people said that their legs still looked or felt better. In another study, 8 in 10 people said that their quality of life had improved in the six months after their operation. They enjoyed life more, felt less self-conscious, could wear clothes that showed their legs, and could do daily tasks and play sport more comfortably.
However, it’s important to know that surgery may not make all of your varicose veins disappear. Some people are disappointed with how their legs look or feel. Also, varicose veins can come back. There isn’t much research to tell us how likely it is that your varicose veins will come back. One good study of people who had surgery found that:
• About 3 in 10 people had varicose veins again five years later
• About 4 in 10 people had varicose veins again 10 years later.
Another study of people who had surgery using different methods found that:
• About 2 in 10 people who had veins stripped out had varicose veins again four years later
• Between 4 in 10 and 5 in 10 people whose veins were just tied off, or who had injections to block the veins, had varicose veins again four years later.
Your varicose veins are more likely to come back if your veins are tied off but not removed, or if only part of the vein between your knee and ankle is removed. Removing the whole vein lowers the chance of varicose veins coming back. But it also increases the risk of nerve injury.

Which type of surgery is best?
The research on the different types of surgery to remove varicose veins is mixed, so we can’t say for certain whether one type of surgery works better than another one. Here’s what the research tells us.
• One study found that varicose veins are less likely to come back if you have a combination of stripping the vein and pulling out small veins through small cuts (avulsion) rather than an operation that just pulls out small veins. But having both techniques may be more painful.
• Taking the vein out through a cut at the top of your leg (inversion stripping) may be less painful than standard stripping with two cuts.
• Sucking out the small veins with a special device (powered phlebectomy) may work as well as making lots of small cuts and pulling them out with a hook (called avulsion or hook phlebectomy). But you’re more likely to get pain and bruising after powered phlebectomy than after hook phlebectomy.
What are the risks of surgery to remove varicose veins?
All operations have risks, and your surgeon should talk to you about the risks of surgery to remove varicose veins. If you have a medical condition such as a heart problem or have had a blood clot, surgery may be more risky for you.
Anaesthetics can have side effects. These are more likely with a general anaesthetic. You may have an allergic reaction to the anaesthetic or get breathing or heart problems. These problems are serious but rare. If you have any allergies, you must tell your doctor.
It’s hard to say exactly how often problems happen, because the research isn’t very good. You can use the statistics we give below as a guide, but it’s important to discuss with your doctor how often problems happen in your hospital.
One large study involving 600 people found that about 1 in 6 people had a problem after their operation. These were mostly minor, such as bruising or swelling, or blisters caused by the bandages rubbing against the skin.
Here are some of the other problems that can happen.
• Nerve damage
• An infection
• Bleeding
• Fluid build-up
• Hard, tender lumps of tissue.
• Brown stains.
• Patches of tiny red veins
• A blood clot.
• Scars
More serious problems relating to varicose vein treatments.
Serious problems are possible, but are very rare. They may not have happened to any of the people your surgeon has treated.
• If the big nerve that runs down the back of your thigh is damaged, it can make your foot floppy and weak. Doctors call this foot drop. In a study of 600 people, only one person got foot drop.
• Very rarely, surgery goes wrong and damages deeper veins. This may make your problems with blood flow worse and lead to more surgery.
• There is a very small chance that you could die from surgery to remove varicose veins. The chance is less than 1 in 1,000.

Varicose vein and spider veins – Other Treatments there?
Surgery is the only way to get rid of varicose veins completely. But it’s a big operation and there are risks. Newer treatments, such as injections, aim to treat varicose veins without the side effects of surgery. But there isn’t enough research for doctors to know if the new treatments are really better.
Varicose Vein Treatment – Injections (sclerotherapy)
Varicose veins can be injected with a chemical that damages the lining of the vein and makes it collapse inwards. A scar forms inside and blocks off the vein. The vein then fades within a few weeks. If you have large varicose veins, the chemical to close the vein may be mixed with a chemical that froths to make a foam. Foam injections spread faster and further through your veins. NICE says ultrasound-guided foam injections can be used to treat people with varicose veins in the NHS. But there isn’t a lot of information yet about how well this treatment works, how safe it is and which patients will benefit most from it.
Varicose Veins – Closing the vein with heat
There are a couple ways a surgeon can do this. In laser treatment, a very thin tube (called a catheter) is threaded through a small hole in your skin into the vein. A laser is then placed in the tube. The intense light from the laser heats your vein and makes it close up.
In radiofrequency ablation, a special heating device is put into the catheter instead. This heats the vein and seals it off.
NICE, the government body that advises doctors, says that both of these treatments are safe enough and work well enough for use in the NHS. But we don’t know the long-term effects of these treatments and you should talk to your doctor about the risks and benefits.
In one study, people were more likely to have unwanted effects from laser treatment than from radiofrequency ablation. Problems included blood clots, pain, swelling and infection of the skin.
Problems were usually short-term. They happened to 2 in 10 people who had laser treatment, compared to less than 1 in 10 people who had radiofrequency ablation.
Stockings, diet and staying active
Your legs may feel better if you stay active, keep your weight down, wear loose clothes and put your legs up when you rest. Some people find that wearing special support stockings (called compression stockings) help achy legs. But there’s no good research to say whether they stop varicose veins getting worse or improve the way legs look.

What will happen if I don’t have surgery?
Varicose veins won’t go away without treatment. They tend to get worse over time, but this normally happens very slowly. If you get varicose veins while you are pregnant, they may go after you have your baby.
It’s unlikely that your varicose veins will cause any serious medical problems. But a small number of people with varicose veins do get complications. This is much more likely to happen if you have problems in your deep veins.
Skin problems affect about 6 in 100 people with varicose veins. Problems include brown, blotchy patches on your legs and ankles, a scaly, dry rash similar to eczema, itchy skin, and thin, papery skin that is easily bruised. Skin problems can lead to open sores (ulcers). Ulcers can be painful and slow to heal, and can get infected. But they aren’t common in people under 60.
Varicose veins can also bleed, even if you don’t knock or bump your leg. The area around your varicose vein may feel tender, red and hot. Doctors call this thrombophlebitis. It is uncomfortable, but not dangerous. You may also get small clots in the blood that pools in your varicose veins, especially after bumping your vein.
It’s unlikely that you will get deep vein thrombosis (DVT) because of your varicose veins. You can get varicose veins after having DVT, but there is no evidence that you can get DVT because of varicose veins.

What can I expect after surgery to remove varicose veins?
Immediately after your operation
When you leave the operating theatre, you will go to the recovery area until you are fully awake. You will probably have a tube in the back of your hand where you were given the anaesthetic. If you had a local anaesthetic, the parts of your leg where the cuts were made will feel numb for several hours. You’ll be able to get up and walk around as soon as the anaesthetic has worn off.
Your legs will be tightly bandaged or you will have special support stockings or tights to wear. You’ll need to wear these for a week to 10 days.
Bruising is normal. Sometimes, a little blood will ooze from the wounds. You may have some soreness and discomfort for several weeks. You will be given a painkiller.
The cuts on your leg will leave small, lumpy scars, but these should fade over time. You may feel tender lumps under the skin on parts of your leg where the varicose veins were removed. These will go away over a few weeks. See your doctor if the lumps become red, swollen and painful.
Going home
You should be able to go home the same day. You are likely to feel tired for the first few days after surgery, and longer if you had surgery on both legs.
You may find it uncomfortable to move around for a few days. If you’ve had surgery on both legs, it may take two weeks or three weeks before you are walking comfortably. But you should try to walk about every half hour or so each day for the first week or two. This helps to reduce your chances of getting a blood clot. When you aren’t walking you should try to put your feet up, with your heels lifted higher than your hips.
Your doctor will advise you on when you can go back to work. You’ll probably need a week or two off. One study showed that most people can get back to work within three weeks. You can have sex as soon as you feel able to. Avoid any strenuous activities or sports for several weeks. You should be able to drive again after a week to 10 days.

http://www.guardian.co.uk/lifeandstyle/besttreatments/surgery-to-remove-varicose-veins

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A professional varicose vein treatment center will stay current with leading-edge vein treatment options for vein disease which for example include duplex ultrasound, ultrasound-guided sclerotherapy and endovenous laser treatment (EVLT ®).

Varicose and Spider Vein Treatments: Duplex ultrasound

Ultrasound is one way to examine problem varicose vein or spider vein below the surface of the skin. This technology is non-invasive. It lets a physician see the varicose or spider veins below the skin surface. It is painless. The physicians can see the blood flow within the veins. So they can determine if you have varicose vein disease, how severe it is. This tools helps them develop the appropriate vein treatment.

Sclerotherapy

Sclerotherapy involves the direct injection of spider veins with a chemical solution called a sclerosant. This solution causes the spider veins to close down and eventually get reabsorbed into the body. Sclerotherapy is considered the gold standard treatment for spider veins and, in the right hands, is a very safe and effective procedure. Multiple sclerotherapy sessions may be required to achieve full clearance of all veins and a complete, cosmetic result.
Some larger veins can be treated with ultrasound-guided sclerotherapy. In this procedure, ultrasound is used to visualize the deeper veins, insure proper needle placement and allowing tracking of injected sclerosant. Ultrasound-guided sclerotherapy is often used in combination with foamed (i.e., mixed with air) sclerosants.

Varicose Vein Treatment with Endovenous Laser Treatment (EVLT®)

EndoVenous Laser Treatment (EVLT, also know as EVLA, ELVeS, EVA). EVLT is FDA-approved for varicose veins, requires only local anesthesia and can usually be performed in 45-minutes in the office. A small laser fiber is inserted into the faulty vein, where laser energy is directed causing the vein to seal shut. Patients can usually resume normal activity within 24 hours – with little to no pain. EVLT is much less traumatic than vein surgery, and has been shown to have higher efficacy.

Ambulatory Phlebectomy

Ambulatory phlebectomy (also called mini-phlebectomy) involves tiny incisions made around large, bulging veins so that they can be directly removed. Phlebectomy can be performed in the office and offers excellent cosmetic results with little discomfort.

Transdermal Laser Treatment

Transdermal laser treatment (or pulsed light therapy) is used for spider vein treatment with a light-based procedure that heats the veins (from the outside). A light beam is pulsed onto the veins in order to close them off and cause them to be dissolved.

Varicose Vein Surgery (Ligation & Stripping)
Use of vein surgery has become extremely limited as the minimally-invasive procedures like EVLT have largely replaced it.

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Every time the word VARICOSE appears in any form in any ad or on any web site for varicose vein and spider vein treatments, it supports those practices which use 1.800.VARICOSE. It may be subtle, it is almost subliminal, it is indirect, but it is true. It is unavoidable that anyone who advertises with the word VARICOSE is in some way promoting the practice using 1.800.VARICOSE. That is part of the power and insurmoutable advantage of using 1.800.VARICOSE.

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Varicose vein treatments that are pretty much of a household therapy in the United Kingdom has been subject to analysis, which has revealed that these therapies have added value to the life of the patients by drastically improving the quality of life. In that respect, United Kingdom is certainly better off with this health investment.

“The conclusion is that if you look at varicose vein treatments in the same sort of terms that we use to assess something like cancer drugs, then it would appear that varicose vein treatment is actually very cost-effective, and quite a good way to use your money,” said lead researcher Jonathan Michaels, a professor of vascular surgery at the University of Sheffield in England.

The review is published in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment program of the National Health Service for the United Kingdom.

The analysis was prompted by the unique problems of the publicly funded U.K. health care system, and uses that country’s cost assumptions. But the research may also provide guidance for American medical practice, where sclerotherapy is gaining in popularity as a varicose vein treatment.

Varicose veins are enlarged, sometimes twisted veins just under the skin caused by a faulty valve that allows a backflow of blood. The condition, which often appears in the legs, can be cosmetically troubling for patients or progress to cause symptoms like heaviness, itching or even a breakdown of theskin.

In the United Kingdom, the high demand for varicose vein treatment has led to some “rationing” of therapy and long health-service waiting lists, Michaels said. “There are a lot of questions about whether minor conditions like varicose veins should really be treated on the NHS when there are competing demands for expensive treatments for more serious diseases, such as cancer,” he said.

Those questions have created an ethical debate about how and where to invest health care resources, he added. Michaels’ technology cost assessment suggests that varicose vein treatment is a good buy.

The study tested the varicose vein treatments for three different groups — patients with mild, moderate and severe varicose veins.

Only the third patient group, of people with severe varicose veins, was large enough show a definitive treatment advantage. Surgery outperformed conservative management, providing the greatest improvements in quality of life, symptoms and patient satisfaction.

Varicose vein surgeries vary, but in a common technique called “ligation and stripping” the defective vein is tied off then removed. Conservative management is a range of measures to care for varicose veins, which can include education and reassurance, advice to elevate the legs or the use of compression stockings.

Once the clinical trial was completed, the research team used both actual data from the study and modeling to compare sclerotherapy versus conservative management, and surgery versus conservative management.

In sclerotherapy, the varicose vein is injected with a chemical that hardens the lining of the vein, which then closes up and dissipates. After injection treatment, pressure is applied to the vein with a stocking or elastic bandages to prevent blood from returning to the treated area.

For sclerotherapy and surgery, Michaels’ team calculated an incremental cost effectiveness ratio, or ICER — a health-economics concept used to evaluate a medical treatment. An ICER measures the incremental benefit of the treatment compared to the next best thing. The lower the ratio, the more cost-effective a treatment is.

“What we found was a small benefit, but for a relatively small cost to the health service,” Michaels said. For patients with minor varicose veins, the economic modeling for sclerotherapy resulted in an ICER of about 3,500 British pounds (roughly $6,450 in U.S. dollars) per unit of improved health status, measured in quality-adjusted life years (QALY).

For patients with moderate varicose veins, the ICER was 3,388 British pounds per QALY for sclerotherapy, 2,083 British pounds per QALY for surgery.

Sclerotherapy is not appropriate for patients with severe varicose veins, so surgery or conservative management were the only treatments assessed for that group. For surgery, costs culled from the actual trial, resulted in an ICER of 7,175 British pounds per QALY. The team’s modeling, which factors in continued benefit beyond the study period, resulted in an ICER of 1,941 British pounds per QALY In all cases, the ICER for sclerotherapy and surgery fell far below the threshold normally considered appropriate for funding by the NHS. The U.K.’s National Institute for Health and Clinical Excellence, which provides national guidance on promoting good health and preventing and treating ill health, suggests a loose upper, acceptable limit of 20,000 British pounds to 30,000 British pounds. (In the U.S. the generally accepted upper limit for an ICER is $50,000 per QALY.)

“So varicose vein treatment is very cost-effective in British health service terms,” Michaels said. With that finding, Michaels makes the case against the rationing of varicose vein therapy in the United Kingdom. Wait-listing delays the benefit patients can gain from relatively inexpensive treatment, he said. A U.K. health-economics analysis does not have great relevance for U.S. physicians, said Frank T. Padberg, Jr., a professor of surgery with the New Jersey Medical School, University of Medicine.

“I think perhaps in the United States, cost-effectiveness takes a second seat than it would in an NHS hospital,” he said. “Almost all standard varicose vein treatments are covered by Medicare and most private insurance.”

Source: Newswise

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I thought this article at about.com was pretty interesting.

Horse Chestnut
The herb horse chestnut (Aesculus hippocastanum) is one of the most widely used natural treatments for varicose veins and chronic venous insufficiency, a related condition.

The active constituent in horse chestnut is a compound called aescin. Aescin appears to block the release of enzymes that damage capillary walls.

In 2006, researchers with the respected Cochrane Collaboration reviewed studies involving the use of oral horse chestnut extract or placebo for people with chronic venous insufficiency.

The researchers found an improvement in the signs and symptoms of chronic venous insufficiency with horse chestnut extract compared with placebo. Horse chestnut extract resulted in a significant reduction in leg pain and swelling compared with a placebo.

Adverse events were usually mild and infrequent. The researchers concluded that based on the evidence, horsechestnut extract was an effective and safe short-term treatment for chronic venous insufficiency. None of the studies, however, evaluated whether the extract could reduce the appearance of varicose veins.

Whole horse chestnut is considered unsafe by the FDA and can lead to nausea, vomiting, diarrhea, headache, convulsions, circulatory and respiratory failure, and even death. Tea, leaves, nuts, and other crude forms of the horse chestnut plant should also be avoided.

Manufacturers of horse chestnut products remove the toxic component, esculin. These products appear to be safe, as there have been few reports of harmful side effects despite being widely used in Europe.

People with kidney or liver disease and bleeding disorders should avoid horse chestnut. The safety of horse chestnut in pregnant or nursing women or children has not been established. Horse chestnut should not be combined with aspirin, Plavix (clopidogrel), Ticlid (ticlopidine), Trental (pentoxifylline), Coumadin (warfarin), and other anticoagulant (“blood-thinning”) drugs unless under medical supervision as these medications may increase the effect of the medication.

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