Medical Edge Newspaper Column

Many Approaches For Dealing With Varicose Veins

Jan. 1, 2006
DEAR MAYO CLINIC:
What is the truth about wearing support stockings for varicose veins? My doctor told me to wear them every day. But I have a friend who was told by her doctor that there's a new approach to this problem and she shouldn't wear them. Which doctor is right?

ANSWER:
Both doctors may be right, as different patients have different needs.

Support stockings, also called compression stockings, are a time-honored treatment for varicose veins. Worn all day long, they put an external pressure on the legs that helps the veins and muscles move blood more efficiently. As the lower-limb muscles, for example, contract, blood in the veins is squeezed up the leg and back to the heart. Because of the stockings' sheer physical pressure, the veins' bulging is reduced considerably.

Some people think of compression stockings as being unstylish, but their negative fashion reputation is no longer deserved. Stockings today come in a variety of strengths, styles and colors. When purchasing them, however, you must be sure that they fit properly. You or your medical-equipment supplier can measure your legs with a tape measure to ensure that you get the right size and fit, according to the chart found on the stocking package. Compression stockings should be strong but not necessarily tight.

Bear in mind that wearing compression stockings is often just the first approach to try before moving on to other treatments, which your friend's case may require. (Most insurance companies require a trial of compression stockings prior to approval of other procedures for varicose veins.)

The traditional surgical option is "vein stripping," a procedure to remove parts of the saphenous vein -- a major vessel, running from ankle to groin, which often enlarges -- and other problem veins. Removing it won't affect circulation in the leg because the remaining deeper veins can take care of the larger volume of blood.

Newer alternatives to vein stripping entail shorter recovery times, little or no scarring, and quicker return to normal activities. Instead of physically removing the vein, minimally invasive surgeries close it off or eliminate it through the use of injected chemicals, heat or other means.

One new option that we have been using with considerable success is called endovenous laser treatment, which involves a catheter advanced through the saphenous vein to the problem branch vein. It is then collapsed by delivery of laser energy -- or, for smaller veins, radiofrequency energy. This procedure is performed on an outpatient basis, and the person may resume normal activities in 24 to 48 hours.

Ideally, the best option for any medical condition is to prevent it in the first place. While there is no way to prevent varicose veins completely, improving your circulation and muscle tone can reduce the risk of developing them.

The universal recommendations to exercise and watch your weight are pertinent here: Walking, for example, is a good way to encourage blood circulation in your legs; and shedding excess pounds takes unnecessary pressure off your veins. It is also useful to avoid high heels and tight clothes around your waist, groin or legs; take several short breaks daily to elevate your legs above the level of your heart; avoid long periods of sitting or standing; and not sit with your legs crossed.

-- Albert G. Hakaim, M.D., Vascular Surgery, Mayo Clinic, Jacksonville, Fla.