Current therapy for primary varicose veins

Chronic venous disease encompasses a broad range of conditions from minor telangiectasia to varicose veins to severe venous insufficiency with venous ulcers. The common underlying mechanism for chronic venous disease is congestion and stasis caused by reversal of venous flow and valve failure. Patients with primary varicose veins have venous congestion limited to the superficial venous system, which means that removal of the affected superficial vessels is curative. Patients with secondary varicose veins have dysfunction of the deep venous system, and the more complex treatment they require is not addressed in this article. In patients with primary varicose veins, valve failure is thought to result from hereditary weakness in the valve leaflets, prolonged standing, hormonal effects, minor direct trauma, or superficial phlebitis. Although the natural history of varicose veins is usually benign, many patients do experience symptoms of achy legs and edema. Treatment options include conservative measures such as compression therapy and leg elevation as well as more invasive vein procedures including sclerotherapy, vein surgery, stab avulsion, and endovenous ablation. While surgery with high ligation and stripping remains the gold standard for treating varicose veins, endovenous procedures have some advantages, including the use of local rather than general anesthetic, earlier return to normal activities, a reduction in periprocedural discomfort, and improved cosmetic appearance. Ultimately, the best treatment is the one tailored to the individual patient based on vein anatomy, symptoms, comorbidities, and preference. Patients with varicose veins (VV) have serpiginous or worm-like raised superficial veins in a lower extremity ( Figure 1 ). Indications for treatment include leg pain, persistent edema, skin damage, and healed or active venous ulcer. The availability of office-based ultrasound and recent technical advances have vastly improved the assessment and treatment options for VV patients. Both conservative and more invasive interventions may be considered, depending on the individual patient. Epidemiology and pathophysiology Chronic venous disease encompasses a broad range of conditions from minor telangiectasia (so-called spider veins) to varicose veins to severe venous insufficiency with venous ulcers. An estimated 10% to 30% of adults are affected by VV. The prevalence of VV is higher in industrialized countries, but can affect patients of any ethnicity. Most studies have found VV to affect women more often than men, with a twofold to threefold predominance. This difference is presumed to Dr Chen is a vascular surgeon at Vancouver General Hospital and a clinical professor in the Department of Surgery at the University of British Columbia. This article has been peer reviewed.