Varicose Veins and Spider Veins Follow-up
- Author: Robert Weiss, MD; Chief Editor: William D James, MD more...
Further Outpatient Care
After treatment of large varicose veins by any method, a 30-40 mm Hg gradient compression stocking is applied and the patient is instructed to maintain or increase his or her normal activity level. O'Hare et al found that compression bandaging for 24 hours, followed by use of thromboembolus deterrent stockings for the remainder of 14 days, gave results comparable to compression bandaging for 5 days. In a randomized trial in patients undergoing foam sclerotherapy for primary uncomplicated varicose veins, no significant difference was noted in vein occlusion, phlebitis, skin discoloration, or pain at 2 and 6 weeks with the 2 techniques.
Most practitioners recommend the use of gradient compression stockings after treatment of spider veins as well as after treatment of varicose veins. The value of compression stockings in this setting is theoretical but is as yet unproven.
Because of the risk of deep vein thrombosis after treatment, immediate duplex ultrasonographic examination is indicated for any symptoms that extend beyond the immediate site of treatment.
Pregnant patients and those with a strong family history of varicose disease may prevent, delay, or ameliorate the problem by wearing 30-40 mm Hg gradient compression hose whenever standing.
Constant use of compression hose can prevent the worsening of existing varicose disease that cannot be treated immediately.
Cesarone et al reported that prophylaxis with 0-(beta-hydroxyethyl)-rutosides (HR) (Venoruton) is effective for controlling flight microangiopathy associated with edema.
Complications of varicose disease include venous ulcers, variceal bleeding, and venous thromboembolism.
Potential complications of treatment include anaphylaxis, changes of pigmentation, ulcerations, paresthesias, arterial injury, and venous thromboembolism.
Patients with significant venous reflux are at high risk for progression to chronic venous ulcers that can be very difficult to treat effectively.
With appropriate treatment, the vast majority of patients have a good outcome.
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