Treatment can be either active or conservative. Active Treatment options include surgery, laser and radiofrequency ablation, and ultrasound-guided foam sclerotherapy. Newer treatments include cyanoacrylate glue, mechanochemical ablation, and endovenous steam ablation. No real difference could be found between the treatments, except that radiofrequency ablation could have a better long-term benefit. Conservative The National Institute for Health and Clinical Excellence (NICE) produced clinical guidelines in July 2013 recommending that all people with symptomatic<unk>  (C2S) and worse should be referred to a vascular service for treatment. Conservative treatments such as support stockings should not be used unless treatment was not possible. The symptoms of<unk>  can be controlled to an extent with the following: * Elevating the legs often provides temporary symptomatic relief. * Advice about regular exercise sounds sensible but is not supported by any evidence. * The wearing of graduated compression stockings with variable pressure gradients (Class II or III) has been shown to correct the swelling, nutritional exchange, and improve the microcirculation in legs affected by<unk> . They also often provide relief from the discomfort associated with this disease. Caution should be exercised in their use in patients with concurrent peripheral arterial disease. * The wearing of intermittent pneumatic compression devices have been shown to reduce swelling and pain. * Diosmin/hesperidin and other flavonoids. * Anti-inflammatory medication such as ibuprofen or aspirin can be used as part of treatment for superficial thrombophlebitis along with graduated compression hosiery – but there is a risk of intestinal bleeding. In extensive superficial thrombophlebitis, consideration should be given to anti-coagulation, thrombectomy, or sclerotherapy of the involved<unk>  * Topical gel application helps in managing symptoms related to<unk>  such as inflammation, pain, swelling, itching, and dryness. Procedures Stripping Stripping consists of removal of all or part the saphenous<unk> (great/long or lesser/short) main trunk. The complications include deep<unk> thrombosis (5.3%), pulmonary embolism (0.06%), and wound complications including infection (2.2%). There is evidence for the great saphenous<unk> regrowing after stripping. For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5% to 60%. In addition, since stripping removes the saphenous main trunks, they are no longer available for use as venous bypass grafts in the future (coronary or leg artery vital disease). Other Other surgical treatments are: * CHIVA method (ambulatory conservative haemodynamic correction of venous insufficiency) is a relatively low-invasive surgical technique that incorporates venous hemodynamics and preserves the superficial venous system. The overall effectiveness compared to stripping, radiofrequency ablation treatment, or endovenous laser therapy is not clear and there is no strong evidence to suggest that CHIVA is superior to stripping, radiofrequency ablation, or endovenous laser therapy for recurrence of<unk> . There is some low-certainity evidence that CHIVA may result in more bruising compared to radiofrequency ablation treatment. * Ambulatory phlebectomy. *<unk> ligation is done at the saphenofemoral junction after ligating the tributaries at the sephanofemoral junction without stripping the long saphenous<unk> provided the perforator<unk>  are competent and absent DVT in the deep<unk> . With this method, the long saphenous<unk> is preserved. * Cryosurgery- A cryoprobe is passed down the long saphenous<unk> following saphenofemoral ligation. Then the probe is cooled with NO2 or CO2 to −85o F. The<unk> freezes to the probe and can be retrogradely stripped after 5 seconds of freezing. It is a variant of Stripping. The only point of this technique is to avoid a distal incision to remove the stripper. Sclerotherapy A commonly performed non-surgical treatment for<unk>  and "spider leg<unk> " is sclerotherapy, in which medicine called a sclerosant is injected into the<unk>  to make them shrink. The medicines that are commonly used as sclerosants are polidocanol (POL branded Asclera in the United States, Aethoxysklerol in Australia), sodium tetradecyl sulphate (STS), Sclerodex (Canada), Hypertonic Saline, Glycerin and Chromated Glycerin. STS (branded Fibrovein in Australia) liquids can be mixed at varying concentrations of sclerosant and varying sclerosant/gas proportions, with air or CO2 or O2 to create foams. Foams may allow more<unk>  to be treated per session with comparable efficacy. Their use in contrast to liquid sclerosant is still somewhat controversial and there is no clear evidence that foam are superior. Sclerotherapy has been used in the treatment of<unk>  for over 150 years. Sclerotherapy is often used for telangiectasias (spider<unk>  and<unk>  that persist or recur after<unk> stripping. Sclerotherapy can also be performed using foamed sclerosants under ultrasound guidance to treat larger<unk> , including the great saphenous and small saphenous<unk> . There is some evidence that sclerotherapy is a safe and may be an effective treatment option for improving the cosmetic appearance, reducing residual<unk> , improving the quality of life, and reducing symptoms that may be present due to the<unk> . There is also weak evidence that this treatment option may have a slightly higher risk of deep<unk> thrombosis. It is not known if sclerotherapy decreases the change that<unk>  return (recurrent<unk> . It is also not known if the type of liquid, substance, or foam used for the sclerotherapy procedure is the most effective and comes with the lowest risk of complications. Complications of sclerotherapy are rare but can include blood clots and ulceration. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready. There has been one reported case of stroke after ultrasound-guided sclerotherapy when an unusually large dose of sclerosant foam was injected. Endovenous thermal ablation There are three kinds of endovenous thermal ablation treatment possible: laser, radiofrequency, and steam. The Australian Medical Services Advisory Committee (MSAC) in 2008 determined that endovenous laser treatment/ablation (ELA) for<unk>  "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and<unk> stripping for the treatment of<unk> ." It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury, and paraesthesia, post-operative infections, and haematomas, appears to be greater after ligation and stripping than after EVLT". Complications for ELA include minor skin burns (0.4%) and temporary paresthesia (2.1%). The longest study of endovenous laser ablation is 39 months. Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency ablation (ERA) compared to open surgery. Myers wrote that open surgery for small saphenous<unk> reflux is obsolete. Myers said these<unk>  should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%. By comparison ERA has been shown to control 80% of cases of small saphenous<unk> reflux at 4 years, said Myers. Complications for ERA include burns, paraesthesia, clinical phlebitis and slightly higher rates of deep<unk> thrombosis (0.57%) and pulmonary embolism (0.17%). One 3-year study compared ERA, with a recurrence rate of 33%, to open surgery, which had a recurrence rate of 23%. Steam treatment consists in injection of pulses of steam into the sick<unk>  This treatment which works with a natural agent (water) has similar results than laser or radiofrequency. The steam presents a lot of post-operative advantages for the patient (good aesthetic results, less pain, etc.) ELA and ERA require specialized training for doctors and special equipment. ELA is performed as an outpatient procedure and does not require an operating theatre, nor does the patient need a general anaesthetic. Doctors use high-frequency ultrasound during the procedure to visualize the anatomical relationships between the saphenous structures. Some practitioners also perform phlebectomy or ultrasound-guided sclerotherapy at the time of endovenous treatment. Follow-up treatment to smaller branch<unk>  is often needed in the weeks or months after the initial procedure. Steam is a very promising treatment for both doctors (easy introduction of catheters, efficient on recurrences, ambulatory procedure, easy and economic procedure) and patients (less post-operative pain, a natural agent, fast recovery to daily activities). Medical Adhesive Also called medical super glue, medical adhesive is an advanced non-surgical treatment for<unk>  during which a solution is injected into the diseased<unk> through a small catheter and under the assistance of ultrasound-guided imagery. The "super glue" solution is made of cyanoacrylate, aiming at sealing the<unk> and rerouting the blood flow to other healthy<unk> . Post-treatment, the body will naturally absorb the treated<unk> which will disappear. Involving only a small incision and no hospital stay, medical super glue has generated great interest within the last years, with a success rate of about 96.8%. A follow-up consultation is required after this treatment, just like any other one, in order to re-assess the diseased<unk> and further treat it if needed.
Varicose veins
Peripheral artery disease
Veinoplus
Peripheral neuropathy
Pseudothrombophlebitis
Pump thrombosis
Superficial vein thrombosis
Purpura