Chronic Venous Disease (CVD)

Treatment 

If you’ve been diagnosed with venous disease (leg vein problems), you’re at greater risk for developing vein problems in the future. That’s why it’s important to do what you can to help prevent your venous disease from getting worse. Like many other heart-related conditions, treatment for venous disease varies according to the nature and severity of the problem but may involve a combination of lifestyle changes, medications, medical procedures, or surgery.

Lifestyle changes

You can make lifestyle modifications that may relieve some of your symptoms and reduce your risk of more serious problems in the future:

1. Eat a healthy diet – A heart-healthy diet is rich in fruits, vegetables, whole grains, and limited in salt and saturated fats. Your doctor may suggest working with a dietician or nutritionist to develop an eating plan.
2. Exercise regularly – Getting regular exercise is one of the keys to heart health because it gets your blood moving. Most doctors recommend incorporating more movement into daily life. For venous disease, walking in a pool is particularly helpful as the water pressure can help reduce swelling. Be sure to check with your doctor before embarking on any exercise plan.
3. Quit smoking – Tobacco use is one of the leading causes of heart health problems. If you don’t smoke, don’t start. If you do smoke, now’s the time to quit. Your doctor is a great resource you can use to help you succeed.
4. Maintain a healthy weight – A healthy diet and a regular exercise program can help you maintain your ideal body weight. Being overweight can worsen venous hypertension and leg swelling.
5. Take your medications – Your doctor may prescribe medications as part of your treatment plan and taking them exactly as prescribed is vital for doing everything you can to help prevent your venous disease from getting worse. If you experience any side effects from your medications, let your doctor know. Just don’t stop taking them without first speaking with your doctor, as doing so can be dangerous.
6. Wear compression stockings – To reduce and prevent pain and swelling from your venous disease, your doctor may recommend that you wear compression stockings. It’s important to check with your doctor to get the right fit and learn how best to use them.
7. Avoid sitting or standing for long periods – Sitting still or standing for long periods of time both reduce blood flow to your legs, thus increasing the symptoms of your venous disease as well as increasing your risk for the development of more serious problems. If sitting for a long time is unavoidable, then put up your feet: Make sure they’re at least six inches above your heart and be sure to raise them a few times each day. If you have to stand for a long period of time, try to take breaks often to sit down and elevate your feet.

Medications

Your doctor may prescribe medication to give you relief from symptoms and to treat your leg vein problem. It’s extremely important that you follow your doctor’s instructions about taking the medication. Some of the medications used to treat venous disease and relieve symptoms include the following:

• Anti-inflammatory drugs such as aspirin or ibuprofen to reduce swelling and relieve pain. These should only be used temporarily.
• Anticoagulants (blood thinners) to reduce the risk of clots getting bigger and the development of new clots.
• Antibiotics to treat infection
• Venotonic medications (such as diosmin, micronized purified protein fraction, horse chestnut extract, hesperidin) may reduce venous swelling and inflammation. 

Medical procedures

Sometimes, venous disease causes such discomfort that the best treatment is to remove the affected vein(s). Removing or closing damaged leg veins prevents blood from pooling and causing discomfort. The blood finds a new path to the heart through healthy veins, and the old veins shrivel up and disappear. Advances in technology have made it possible to treat veins with minimally invasive procedures that are generally less painful, have fewer complications, and require less time for recovery. Treated veins can reappear, but taking steps such as regular exercise and wearing compression stockings may make it less likely and reduce the risk of new problems in the veins. 

Two minimally invasive procedures commonly used to treat varicose and spider veins are the following:

• Sclerotherapy – This procedure involves the injection of either a liquid or foam solution to shrink the vein until it eventually disappears. This procedure is typically performed in a doctor’s office and doesn’t require anesthesia. It’s primarily used to treat smaller varicose veins and spider veins. Sclerotherapy can require multiple treatments every four to six weeks to eliminate the problem veins. And while some stinging and redness may occur at the site of the injection, as well as bruising and swelling, most patients can return to their normal activities immediately after the 20- to 30-minute procedure.
• Venous ablation – This procedure uses lasers or radiofrequency heat energy generated from a device inserted into the affected vein through a catheter. The heat energy the device creates closes the vein that’s not working and can also be performed in a doctor’s office but with local anesthesia. It usually takes less than an hour. There’s some risk of bruising and numbing with this procedure, but most patients experience little pain after the treatment and can return to their normal activities soon after. 

If your venous disease is in the deep venous system (veins that you cannot see on the surface of your skin), and those veins are narrowed, the following interventional procedures may be used instead: 

• Inserting and opening a small balloon (or inserting a stent) in the vein that will open up the vein wider to allow blood to flow more freely through it
• Placing filters inside the major vein in the abdomen to catch blood clots that break free from leg or pelvic veins before they reach the heart and lungs

Surgery

Surgery is an option for treating severe venous disease. Depending on the nature of your problem and other considerations, your surgical options may include the following:

• Removing a vein, part of a vein, or a vein valve (often referred to as vein stripping and ligation) and ligating, or tying off, the vein to redirect blood flow to healthy veins

Special considerations

• Deep vein thrombosis (DVT) – This type of blood clot should be treated as soon as possible; otherwise, it can develop into a pulmonary embolism (PE), which is the third leading cause of cardiovascular death.¹
• Pregnancy – Pregnancy can cause varicose veins to become larger and more obvious and painful. While it’s important to be on the lookout for blood clots, your doctor may recommend conservative therapies such as compression and elevation, as varicose veins commonly appear with each pregnancy.

 Comparison of treatments 

• Many cases of CVD often benefit from compression therapy and lifestyle changes.
• Minimally invasive options like sclerotherapy or ablation are effective for moderate to severe CVD conditions.
• Patients should discuss their symptoms, CVD severity, and goals of care with a healthcare provider to select the best treatment strategy. 

References

1. American Heart Association (AHA)