Varicose Veins and Spider Veins Follow-up

  • Author: Robert Weiss, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 7, 2010
 

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.[8]
  • 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.
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Deterrence/Prevention

  • 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.[9]
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Complications

  • 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.
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Prognosis

  • 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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Patient Education

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Contributor Information and Disclosures
Author

Robert Weiss, MD  Associate Professor, Department of Dermatology, Johns Hopkins University School of Medicine

Robert Weiss, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American Dermatological Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and MedChi

Disclosure: Angiodynamics Honoraria Speaking and teaching; CoolTouch Corp Intellectual property rights Consulting; Cynosure Grant/research funds Independent contractor; Palomar Grant/research funds Independent contractor

Coauthor(s)

Craig F Feied, MD, FACEP, FAAEM, FACPh  Professor of Emergency Medicine, Georgetown University School of Medicine; General Manager, Microsoft Enterprise Health Solutions Group

Craig F Feied, MD, FACEP, FAAEM, FACPh is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Phlebology, American College of Physicians, American Medical Association, American Medical Informatics Association, American Venous Forum, Medical Society of the District of Columbia, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Kelly M Cordoro, MD  Assistant Professor of Pediatric and Adult Dermatology, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Racette S, Sauvageau A. Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins. Am J Forensic Med Pathol. Sep 2005;26(3):294-6. [Medline].

  2. Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. Oct 2005;30(4):422-9. [Medline].

  3. Nael R, Rathbun S. Treatment of varicose veins. Curr Treat Options Cardiovasc Med. Apr 2009;11(2):91-103. [Medline].

  4. Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. Jan 2009;60(1):110-9. [Medline].

  5. Goldman MP. Sclerotherapy: Treatment of varicose and telangiectatic leg veins. 2nd ed. St. Louis, Mo: Mosby-Year Book; 1995:1-519.

  6. Rao J, Wildemore JK, Goldman MP. Double-blind prospective comparative trial between foamed and liquid polidocanol and sodium tetradecyl sulfate in the treatment of varicose and telangiectatic leg veins. Dermatol Surg. Jun 2005;31(6):631-5; discussion 635. [Medline].

  7. Dudelzak J, Hussain M, Goldberg DJ. Vascular-specific laser wavelength for the treatment of facial telangiectasias. J Drugs Dermatol. Mar 2009;8(3):227-9. [Medline].

  8. O'Hare JL, Stephens J, Parkin D, Earnshaw JJ. Randomized clinical trial of different bandage regimens after foam sclerotherapy for varicose veins. Br J Surg. May 2010;97(5):650-6. [Medline].

  9. Cesarone MR, Belcaro G, Ricci A, et al. Prevention of edema and flight microangiopathy with Venoruton (HR), (0-[beta-hydroxyethyl]-rutosides) in patients with varicose veins. Angiology. May-Jun 2005;56(3):289-93. [Medline].

  10. Feied CF. Peripheral venous disease. In: Rosen, Barkin, eds. Emergency Medicine Principles and Practice. Vol 3. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998:Chapter 107.

  11. Leopardi D, Hoggan BL, Fitridge RA, Woodruff PW, Maddern GJ. Systematic review of treatments for varicose veins. Ann Vasc Surg. Mar 2009;23(2):264-76. [Medline].

  12. Ramelet AA, Monti M. Phlebology: The Guide. 4th ed. Paris, France: Elsevier; 1999:1-445.

  13. Sadick NS. Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure. Dermatol Clin. Jul 2005;23(3):443-55, vi. [Medline].

  14. Tretbar LL. Venous Disorders of the Legs: Principles and Practice. ed. London, England: Springer Verlag; 1999:1-139.

  15. Weiss RA, Feied CF, Weiss MA. Vein Diagnosis & Treatment: A Comprehensive Approach. ed. New York, NY: McGraw-Hill; 2001:1-304.

 
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Patient with large tortuous varicose veins, high-volume venous reflux, and early stasis changes of the medial ankle.
Typical chronic medial leg ulceration associated with long-standing venous insufficiency. The ulcer had been present for 12 years and was refractory to every treatment approach until treatment of the refluxing superficial varices was performed. Treatment consists of endovenous ablation, foam sclerotherapy, or ambulatory phlebectomy.
 
 
 
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