Selecting a treatment for primary varicose veins
Tremblay, J.; Lewis, E.W.; Allen, P.T.
Canadian Medical Association Journal 133(1): 20-25
1985
ISSN/ISBN: 0008-4409 PMID: 3891060 Document Number: 252159
At present 3 treatment alternatives for primary varicose veins are available: surgical stripping and ligation, injection/compression sclerotherapy, and a combination of the 2. At least 4 factors contribute to the decision of whether to treat the patient: pregnancy, obesity, oral contraceptive (OC) use, and age. Since varicose veins in pregnant women may later recede, only palliative treatment is recommended before delivery. Deep vein thrombosis may develop as a result of OC use during varicose vein treatment, leading some to advise OC discontinuation. Numerous clinical trials have endeavored to examine the relative effectiveness of treatment methods currently in use. The only randomized trial to evaluate all 3 treatment options over a 3-year period found that surgical stripping was significantly more effective than a combination of ligation and sclerotherapy, and that the combination was significantly more effective than sclerotherapy alone. Surgery appears to be the recommended treatment when the saphenous system is involved; surgery is also preferred for patients 35-64 years of age and for those presenting with signs of ankle edema and flare. Sclerotherapy seems to be more effective for dilated superficial veins and incompetent perforating veins in the lower leg. In addition, sclerotherapy is the most acceptable and least expensive method for the patient. The prevalence of primary varicose veins has been estimated at 20% in Europe and North America, with a female:male ratio of 5:1.