There is very little evidence that any specific measures are helpful in preventing varicose veins. However limiting or modifying some of the contributing factors may be helpful in preventing progression of varicose veins. It is likely that exercise, avoiding be overweight and avoiding long periods of standing stationary might be helpful. You should also avoid wearing garments (socks or stockings) that restrict the blood flow from your legs. It may be helpful to avoid constipation and it may also be useful to avoid wearing high heel shoes for prolonged periods of time as these shoes mean the calf muscle is unable to provide an optimal pumping effect. There doesn’t seem to be much evidence that crossing your legs has any effect on varicose veins.

Spider veins are invariably treated with Sclerotherapy whereby a small amount of solution (the sclerosant) is injected into the abnormal veins to close them off. The body then dissolves these treated veins. Laser treatment of spider veins has produced inferior results to Sclerotherapy. As with all medical treatments the skill of the treating doctor is a critical component to achieving a successful result. The Australasian College of Phlebology has a register of doctors credentialed to perform certain procedures. Varicose veins are increasingly being treated less with surgery (“vein stripping”) and more with the “non-surgical” procedures of Ultrasound Guided Sclerotherapy (UGS) and Endovenous Laser Ablation (ELA). Some Phlebologists still perform adjunctive surgery (ambulatory phlebectomies) in association with one of the non-surgical techniques. Whether UGS or ELA is used depends on many factors with the most important being the size of the vein being treated. The larger the veins are more likely to be treated with ELA.

Compression stockings

These come in a variety of compression strengths ranging from support pantyhose to Class 3 medical compression stockings. In between are the compression stockings that are useful in the prevention of DVT’s when flying and the anti-embolism stockings that are often work in hospital. After Sclerotherapy it is usual for a Class 2 stocking to be worn from 3 days to 2 weeks depending on which vein was treated. As an adjunct to wearing stockings it is important to do as much walking as is possible.

Endovenous techniques (radiofrequency and laser)

In many countries Endovenous Laser Ablation (ELA) is replacing, or has replaced, the traditional surgical “stripping” of veins. The reasons for this are that ELA can be done as an office procedure (walk-in, walk-out) and has less risk than surgery. It also does not have the recovery time associated with surgery. The long term results of ELA are excellent. Importantly the recurrence rate of new varicose veins after surgery, which is often very concerning for patients, is avoided by performing ELA. The technique of ELA consists of placing a small laser fibre up the middle of the vein. This fibre is then very slowly withdrawn from and the laser energy from the tip of the fibre then heat seals as it is withdrawn. The laser is introduced via a 3-4 mm cut (done under local anaesthetic) and the procedure itself is also done under local anaesthetic. Normal walking is possible straight away as the local anaesthetic is not into the muscles but only placed around the vein being treated. The actual laser treatment is painless although some patients report a buzzing sensation.

Interestingly there is no dictionary definition of what constitutes a varicose vein but it is generally accepted that if a vein is “raised” above the surface then it is a varicose vein. What is critical in the management of varicose veins is the determination of the underlying anatomy. Almost all significant varicose veins are associated with an underlying vein that has valves that do not work and allow back pressure (with standing and gravity). This back pressure “forces” its way to the skin as varicose veins. The best and least invasive way to determine the state of the underlying anatomy is to have a Duplex Ultrasound examination. This examination gives a clear understanding of which veins are working (competent valves) and which veins have valves that are not working (incompetent valves / veins). It is only with this information that the treatment options be considered. There are many doctors who can look at veins but the special interest group called Phlebologists are playing an increasing role in assessment and management of all vein conditions.

Spider veins are NOT dangerous and present a cosmetic concern although they can occasionally be associated with some minor aching particularly after prolonged standing. Varicose veins on the other hand can be associated with Deep Vein Thrombosis, Pulmonary Embolism, ulceration of the skin (usually around the ankles), cellulitis (if the damaged skin gets infected) and significant bleeding episodes if the varicose vein is traumatised and bursts. For many people though varicose veins are small and not associated with much in the way of symptoms and the risk of the aforementioned problems is low.