Pulsed light therapy or laser therapy cause vessel sclerosis by heating the hemoglobin in the vessels. Sessions are scheduled at 6- to 12-week intervals and may cause pain, blistering, hyperpigmentation, and superficial erosions. The treatment is indicated for patients unable to experience effective results using sclerotherapy. Laser therapy is also performed on patients with isolated small telangiectasias.
Sclerotherapy is a possible form of treatment for patients with varicosities. The direct IV injection of a sclerosing substance causes inflammation and destroys superficial varicose veins less than 5 mm in diameter. Substances may include hypertonic saline, polidocanol, and glycerine. The procedure is performed in an office setting. Although sclerotherapy causes minimal discomfort, potential complications include itching, pain, edema, inflammation, hyperpigmentation, and venous thromboembolism. To maintain pressure over the vein, a thigh-high elastic compression stocking is worn for several days after the procedure.
Surgical removal of the affected vein, usually the greater saphenous vein, is indicated in patients with recurrent superficial venous thrombosis or chronic venous insufficiency. The procedure involves the removal of the entire vein, including its incompetent branches, by using a tissue resector to destroy the varices and aspirating the pieces for removal. Since potential complications include bleeding and infection, a less invasive procedure is endovenous ablation of the vein. The insertion of an energy-emitting catheter causes collapse and sclerosis of the vein. Potential complications of ablation therapy include bruising, paresthesia, and reopening of the vein.
In individuals with varicosities, prolonged standing or sitting may experience a heavy, achy feeling or pain. Walking or elevating the limbs helps relieve the pain. To prevent symptoms of varicose veins, instruct the patient to avoid prolonged standing or sitting.
Long-term compression therapy prevents increased venous pressure exacerbating varicose veins. Custom-fitted thigh-high elastic compression stockings are used to help improve circulation of the lower extremities. For optimal results, instruct the patient to apply stockings in bed before getting up in the morning.
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