欧洲慢性静脉疾病诊疗指南 | ESVS第十章 患者信息--(八) (九)

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Conservative measures include exercise, weight loss, physiotherapy, leg elevation at rest, medication aiming to improve the function of the veins, and compression treatment of the leg. The latter comes in many types, with elastic stockings and bandages being most commonly used. Compression garments compress the dilated veins and reduce the pooling of blood in the legs. Additionally, they can prevent leg swelling. The result is improvement of patient symptoms and quality of life. It is important to wear the stockings most of the time during the day, to obtain the best results. Compression stockings may be difficult to put on and take off, but specific aids are available to help.

10.9. How can I be treated for varicose veins and related superficial venous disease?

For many years, surgical “stripping” of the damaged superficial veins was the classical method to treat varicose veins and related problems. However, in the last 20 years, newer alternative methods have been developed to close the vein by using local heat or another method that can interact with the vein wall. These advances have been helped by the widespread availability of ultrasound, which is not only used for diagnosis but also to guide superficial venous treatment.

The most common heat treatments make use of “laser” or “radiofrequency ablation”, where a special fibre is carefully inserted into the vein and, after injection of anaesthetic, the fibre is used to heat and close the inside of the vein. These procedures do not require a big operating room and can easily be done in the outpatient setting. Most patients recover without any problem and can swiftly resume their normal activities.

In recent years, yet more alternative methods to close the saphenous vein have been developed. These techniques do not use heat and hence no anaesthetic needs to be injected to numb the vein. Instead of heat, mechanical and chemical irritation of the vein wall leads to closure of the vein, or the vein is closed with surgical glue. Other techniques, known for many years, have also been optimised. For instance, injection of a diseased vein with a chemical solution called “sclerotherapy” has been converted into “foam sclerotherapy”, where white foam, made by mixing the sclerosant solution with air, is injected into the vein.

Whereas the availability of all these “minimally invasive” treatment methods for varicose veins may be a real benefit for patients, treatment choice has become very complicated. Therefore, it is important for the treating physician to discuss the pros and cons of different potential treatments with their patient. It should be a shared decision between the patient and the treating physician, to decide which treatment is likely to be the most appropriate for each individual. As varicose veins are never exactly the same between one patient and the other, a “patient tailored” treatment approach is needed.

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International Angiology

(Chinese Language Editor中文主编)

Vascular Investigation and Therapy

(副主编)

Phlebology

Frontiers in Cardiovascular Medicine

Vascular Medicine

Cell

Vein and Lymphatic

中华医学杂志

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