There is very little evidence that any specific measures are helpful in preventing varicose veins. However limiting or modifying some of the contributing factors may be helpful in preventing progression of varicose veins. It is likely that exercise, avoiding be overweight and avoiding long periods of standing stationary might be helpful. You should also avoid wearing garments (socks or stockings) that restrict the blood flow from your legs. It may be helpful to avoid constipation and it may also be useful to avoid wearing high heel shoes for prolonged periods of time as these shoes mean the calf muscle is unable to provide an optimal pumping effect. There doesn’t seem to be much evidence that crossing your legs has any effect on varicose veins.

Spider veins are invariably treated with Sclerotherapy whereby a small amount of solution (the sclerosant) is injected into the abnormal veins to close them off. The body then dissolves these treated veins. Laser treatment of spider veins has produced inferior results to Sclerotherapy. As with all medical treatments the skill of the treating doctor is a critical component to achieving a successful result. The Australasian College of Phlebology has a register of doctors credentialed to perform certain procedures. Varicose veins are increasingly being treated less with surgery (“vein stripping”) and more with the “non-surgical” procedures of Ultrasound Guided Sclerotherapy (UGS) and Endovenous Laser Ablation (ELA). Some Phlebologists still perform adjunctive surgery (ambulatory phlebectomies) in association with one of the non-surgical techniques. Whether UGS or ELA is used depends on many factors with the most important being the size of the vein being treated. The larger the veins are more likely to be treated with ELA.

Compression stockings

These come in a variety of compression strengths ranging from support pantyhose to Class 3 medical compression stockings. In between are the compression stockings that are useful in the prevention of DVT’s when flying and the anti-embolism stockings that are often work in hospital. After Sclerotherapy it is usual for a Class 2 stocking to be worn from 3 days to 2 weeks depending on which vein was treated. As an adjunct to wearing stockings it is important to do as much walking as is possible.

Endovenous techniques (radiofrequency and laser)

In many countries Endovenous Laser Ablation (ELA) is replacing, or has replaced, the traditional surgical “stripping” of veins. The reasons for this are that ELA can be done as an office procedure (walk-in, walk-out) and has less risk than surgery. It also does not have the recovery time associated with surgery. The long term results of ELA are excellent. Importantly the recurrence rate of new varicose veins after surgery, which is often very concerning for patients, is avoided by performing ELA. The technique of ELA consists of placing a small laser fibre up the middle of the vein. This fibre is then very slowly withdrawn from and the laser energy from the tip of the fibre then heat seals as it is withdrawn. The laser is introduced via a 3-4 mm cut (done under local anaesthetic) and the procedure itself is also done under local anaesthetic. Normal walking is possible straight away as the local anaesthetic is not into the muscles but only placed around the vein being treated. The actual laser treatment is painless although some patients report a buzzing sensation.

The most important factor in whether or not you will develop varicose veins is your genetic background. This situation can be aggravated by relative inactivity, occupation (prolonged standing), pregnancy, constipation, wearing high heel shoes, being overweight and advancing age. There is also some evidence that dietary factors may have some influence but the specific foods have not been identified.

This is a question that I am often asked to which I reply.... “If the quality of treatment is high the treatment frequency will be low”.

Specifically for surface veins, if the reticular veins (the blue / green veins that lead into spider veins) are treated prior to treating the spider veins then not only is the treatment more effective but it lasts a lot longer. For example, a 40 year old lady would usually get between 5 – 10 years between treatments if treated correctly. This time between treatments extends as people get older. The treated veins do not come back but there will be new veins grow over time for the same reason that the original veins grew – genetics!

If the reticular veins are not treated first then not only do patients often get a poor result but they require frequent treatment (every 6 -12 months) because the treated spider veins will just keep reappearing. There is also a higher incidence of the complication of “matting” if the reticular veins are not treated.

Why don’t all doctors treat veins this way? Sadly because the training of some doctors is less than optimal or their real interest lies elsewhere. For deeper veins treated with either Ultrasound Guided Sclerotherapy or Endovenous Laser Ablation, the results are invariably long term and often permanent with any recurrence usually minor in nature and easily treated. These successful results will only occur if the treating doctor is very well trained and experienced.

I have recently seen the full page advertisement in The Sunday Mail for yet another product claiming to be helpful in the management of varicose veins and spider veins.

These products seem to appear with monotonous regularity like diet pills and exercise equipment etc. Interestingly, the product “has been specifically developed for people suffering from varicose veins, spider veins etc.” and that it has been “designed to strengthen your vein walls, reduce inflammation etc.”, yet I have been unable to find any scientific evidence (either in the advertisement or on the website) that the product achieves what it has been designed and developed for. There is very frequent use of the word “may” in the advertisement e.g. Grape seed extract may inhibit ….., Veins Clear may assist with the pain ……, Grape seed extract may help reduce the risk etc. but there is no supporting documentation (regarding clinical trials) that Veins Clear does in fact help anyone. This is in stark contrast with all medical products that cannot be released into the market UNTIL they have a demonstrated benefit and have undergone rigorous impartial testing. Any published papers,  in credible medical journals, requires satisfactory peer review which means that the claims made are substantiated by people with no vested interest in the product.  I have been unable to find any such papers relating to Veins Clear.

You can be the judge but it is my opinion that this product will provide no demonstrable benefit to anyone and the advertisement is just very clever marketing.

Tell me what you think - leave your comments, questions or feedback below.

CLOTHING AND SUPPORT GARMENTS

If you have varicose veins in your legs, try to be dressed comfortably — wear lose clothing avoiding any type of restrictive clothing on the waist or legs under garments that hinder circulation.

Swap your your high heels for low heeled shoes. Low-heeled shoes work calf muscles!

Invest in support garments such as elastic socks, stockings or pantyhose for your legs. These types of support garments compress leg veins and aid circulation which can bring relief to aching legs. There are a wide range of support garments in pharmacies and hosiery sections in department stores.

BODY WEIGHT AND DIET

If you have varicose veins, keep your body weight in acceptable ranges. Lose Weight if you are over-weight. Extra body weight can cause unnecessary pressure on your leg veins. You can check your body weight here on the Measure Up Australian Government website.

Follow a healthy diet. Reduce salt intake. Excess salt can make your body retain water which will again put extra pressure on your leg veins.

Eat more high fibre foods. Avoid constipation as this can not only cause haemorrhoids but will add extra pressure on your entire circulatory system including your leg veins.

EXERCISE AND MOVEMENT

Participate in regular exercise. Simply walking will help your circulation.  Other sports and exercise such as tennis, running, cycling, dancing and swimming all help with circulation.

Avoid being static (sitting or standing) for long periods as this causes the blood in your legs to pool. Move often. If you move your muscles will help the veins circulate your blood.

If you are resting, raise / elevate your legs whenever possible.