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How can varicose veins showing refluxes be treated?

Q: I am a 48 years old man having a problem of varicose veins showing refluxes. Should I go for surgery or can it be controlled by using stockings in both the legs?

A:If there is reflux of the veins detected on the duplex scan, then chances are that surgery is indicated. This most often takes the shape of ligation at the site of reflux and removal of the incompetent vein, either by stripping or by avulsion. This however does not mean that surgery is mandatory in all patients, as some patients may not be fit or willing for surgery. Also, if the reflux is associated with DVT (Deep venous thrombosis, new or old) then perhaps stockings are a better option as it in these cases that stockings are a safe substitute. There are cases where the stocking may have to be used even after surgery, as the reflux is not only in the varicose superficial veins, which are operable but deep veins as well. There are certain precautions with this modality of treatment.

  • The stockings have to be graduated compression stockings (which have high compressive strength distally at the feet and reducing as these go higher), preferably custom made or selected from wide variety of sizes.
  • Arterial circulation has to be assessed and if it is compromised then it may be better to have surgery done for the veins or use low-pressure stockings.
  • If there are venous ulcerations then again also better to have surgery done as soon as the ulcers are healed and not rely on stockings alone. The chances of skin breakdown are high in these cases.

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