Treating Varicose Veins

It's a safe bet that no one who has varicose veins is happy about it.  Twisted and bulging, these overblown blood vessels call attention to themselves as they create a tortuous course in their insufficient path back to the heart.  Varicose veins, or 'varicosities,' as they as known in the parlance, aren't merely unsightly.  They're also associated with an increased risk for inflammation of the vessel known as phlebitis, and for clot formation that can turn deadly.  Now a study in Archives of Dermatology, a journal Rick and I freely admit in this week's podcast is not one we turn to often, directly compares two treatments for varicose veins to assist those who have them to make an informed decision.  And in view of the fact that one-third, yes folks, that's right, about 33% of us, will develop varicose veins, it's about time.

400 patients with chronic venous insufficiency (more jargon) of the great saphenous vein (that's the huge vein that starts in the foot and makes its way up the leg) were randomized in this study to either the longstanding treatment known commonly as vein stripping or endovenous (inside the vein) laser treatment.  Subjects were followed for two years after treatment.

Outcomes assessed in this study included patient satisfaction, recurrence of varicosities, an ultrasound study of the veins, quality of life, adverse events, and assessment of blood flow.  Here's what they found: recurrence in the laser group was about 16% while the vein stripping group experienced 23% recurrence, but ultrasound detected more recurrence following the laser procedure.  Both treatments improved quality of life and the medical condition, while the laser treatment was associated with more adverse events such as tightening of the treated area, loss of pigmentation, and inflammation of the vessel. 

In summary, Rick opines that this study should allow patients to take part in their own treatment decision-making and renders both options more or less equivalent.  He points out that longer term follow-up would be desirable as two years is relatively brief given that some tendency toward recurrence detected with ultrasound was seen.  My two cents is that vein stripping is a bigger procedure than the laser treatment, so in consideration of up front factors might very well cause me to choose that option.  We both applaud the fact that such a head to head comparison has now been published.

It would be remiss of us not to mention that there are more conservative strategies to manage varicose veins such as elevating the affected legs and use of compression stockings that can certainly be attempted before a procedure is undertaken.  It is generally true though, that once varicose veins start to develop there's no way to repair them short of such procedures.

Other topics this week include a review of the predictive value of EKGs (ECGs) in people without symptoms of heart disease in Annals of Internal Medicine, a great news study about a vaccine for the major viral cause of diarrhea in children in NEJM, and a look at the relationship between stroke and depression in JAMA.  Until next week, y'all live well.

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