Feature Article

An update on the management of varicose veins

G Mark Malouf



Varicose veins are a common complaint, and patients may present with symptomatic venous problems, cosmetic complaints or vascular complications. The key planks of treatment are graduated compression stockings, sclerotherapy and surgery.

Key Points

  • Varicose veins present in many shapes and sizes. They may or may not produce symptoms.
  • Be careful when ascribing leg symptoms specifically to the veins. There are many causes to consider.
  • Compression sclerotherapy is the treatment of choice for reticular veins, dilated venules and telangiectasias. Its use is extending into the larger tributary veins, recurrent veins and even large primary veins. Ultrasound guidance has enhanced this treatment greatly.
  • Surgery delivers longer term control of larger varicose veins than does sclerotherapy alone. Ambulatory phlebectomy is becoming increasingly popular.
  • It is not sensible to promise patients a ‘cure’ for their varicose veins. More realistic outcomes are significant disease control for a long period of time and improvement in symptoms and appearance. The patient and treating doctor must discuss the potential risks and benefits of treatment before commencement.