Varicose Veins Treatment Options

Varicose veins are abnormally dilated and tortuous superficial veins, most commonly observed in the lower extremities, where the effects of gravitational forces and venous pressure are most pronounced. While often dismissed as merely a cosmetic concern, they represent a chronic venous disorder indicative of underlying circulatory dysfunction and sustained hemodynamic imbalance. As the condition progresses, varicose veins may contribute to cumulative changes in the surrounding soft tissues, including chronic edema, dermal fibrosis, and alterations in skin pigmentation. In advanced stages, persistent venous congestion can compromise microcirculatory perfusion, increasing the risk of dermal breakdown and the development of complex skin lesions. Beyond physical discomfort and aesthetic implications, varicose veins can significantly impair functional capacity, limiting mobility, reducing exercise tolerance, and affecting overall quality of life. Modern advancements in vascular care have facilitated the development of effective strategies to support venous health, restore physiologic blood flow, and mitigate the long-term impact of this condition on limb function and systemic well-being.

In clinical practice, varicose veins are also increasingly recognized for their systemic implications, particularly in individuals with coexisting vascular or metabolic conditions. Prolonged venous hypertension may exert secondary effects on lymphatic function and tissue oxygenation, compounding the risk of chronic inflammation and tissue remodeling. Additionally, psychological factors such as self-consciousness and reduced self-esteem are not uncommon, particularly when visible vein distortion impacts the patient’s body image. As part of a holistic approach to care, comprehensive venous assessments and ongoing monitoring are essential in identifying progression and ensuring timely intervention to preserve both vascular integrity and patient quality of life. 

Why Cuba

Cuban vascular surgeons are highly trained specialists in the evaluation and management of venous insufficiency, encompassing both superficial and deep vein disorders that may compromise circulatory efficiency. Their expertise lies in the use of advanced diagnostic modalities—such as duplex ultrasonography, venous mapping, and hemodynamic studies—to assess the severity and extent of venous dysfunction. This allows them to determine whether visible vein abnormalities are limited to cosmetic concerns or indicative of more significant underlying vascular compromise. Based on these findings, Cuban vascular surgeons are equipped to carry out a range of interventional and surgical procedures, including minimally invasive techniques aimed at restoring venous competence and preventing complications related to chronic venous disease.

Cause of Varicose Veins

Varicose veins are caused by venous valve dysfunction. In healthy veins, one-way valves keep blood moving upward toward the heart. When these valves weaken or fail, blood flows backward and collects in the vein, causing it to stretch, twist, and become visible under the skin.

Common Contributing Factors:

• Prolonged standing or sitting
• Pregnancy
• Obesity
• Aging
• Family history of vein disease
• Hormonal changes
• Previous deep vein thrombosis (DVT)

Types and Classification of Varicose Veins

Varicose veins are classified based on size, location, and severity:

C1 – Telangiectasias or Spider Veins

• Small, dilated superficial veins typically less than 1 mm in diameter, visible as fine red or blue lines on the skin.
• Generally cosmetic in nature but may indicate the early stages of venous hypertension or underlying venous insufficiency.

C2 – True Varicose Veins (≥3 mm in diameter)

• Enlarged, bulging, and twisted veins measuring 3 mm or more, most commonly seen in the legs.
• May reflect valvular dysfunction in the superficial venous system and are often associated with symptoms such as heaviness, aching, or fatigue.

C3 – Edema Without Skin Changes

• Persistent swelling of the lower limbs, usually worse at the end of the day and relieved with elevation.
• Indicates fluid accumulation due to chronic venous pressure, but without visible damage to the skin or subcutaneous tissues.

C4 – Skin Changes (e.g., Pigmentation or Eczema)

• Includes hyperpigmentation, venous eczema, lipodermatosclerosis, or atrophie blanche due to chronic inflammation and venous congestion.
• Reflects long-standing venous insufficiency and microcirculatory compromise, increasing the risk of ulcer development.

C5 – Healed Venous Ulcer

• Refers to the complete epithelial closure of a previously open venous ulcer, typically around the medial ankle region.
• Indicates prior advanced venous disease, and requires ongoing maintenance therapy to prevent recurrence.

C6 – Active Venous Ulcer

• An open, non-healing wound most commonly located on the lower leg or ankle, associated with significant venous hypertension.
• Represents the most severe stage of chronic venous disease, requiring comprehensive wound care, compression therapy, and vascular intervention.

Varicose veins may also be categorized into:

Superficial Varicose Veins

• Abnormally enlarged, twisted veins located in the superficial venous system, just beneath the skin most commonly appear in the legs and are visible to the naked eye.
• Caused by valve dysfunction, leading to blood pooling and increased venous pressure.
• May indicate underlying venous insufficiency.

Reticular Veins

• Small, flat, bluish veins typically measuring 1–3 mm in diameter which are often found in clusters on the thighs, behind the knees, or around the ankles.
• Usually not raised and often considered a cosmetic concern but may cause localized discomfort or serve as feeder veins to spider or varicose veins.
• Presence may indicate early venous dilation.

Perforator Vein Incompetence

• Incompetence occurs when valves fail, causing reverse flow (reflux) from deep to superficial veins leading to increased pressure in the superficial veins.
• Can contribute to varicose veins, chronic swelling, skin changes, and even ulcers.
• Important to identify in patients with chronic venous insufficiency.

Deep Vein Reflux (Advanced Venous Disease)

• Refers to valve failure in the deep venous system, allowing backward blood flow.
• Considered a more advanced form of venous insufficiency.
• Associated with significant venous hypertension, leg pain, chronic edema, and skin damage.
• Can lead to serious complications such as:
  • Venous stasis dermatitis
  • Venous leg ulcers
• Requires duplex ultrasound for diagnosis and may need specialized intervention.

Treatment Options

Treatment depends on the severity of symptoms, the extent of venous reflux, and patient preferences. Options range from conservative therapy to surgical intervention.

Conservative Treatments:

• Compression stockings
• Leg elevation
• Physical activity
• Weight management
• Anti-inflammatory medications

Interventional and Surgical Treatments:

For individuals who are experiencing discomfort or complications, a range of interventional and surgical procedures are available to improve venous circulation, alleviate symptoms, and enhance cosmetic appearance. These treatments are selected based on the severity of the condition, the vein’s anatomy, and the patient’s overall health and goals.

Surgical or interventional treatment becomes necessary when:

• Varicose veins cause persistent pain, heaviness, or swelling
• Skin changes (e.g., hyperpigmentation, eczema) are present
• There are recurrent episodes of bleeding or thrombophlebitis
• Venous ulcers develop or fail to heal
• The patient has failed to improve with conservative therapy

Sclerotherapy

• A minimally invasive procedure where a medical solution (sclerosant) is injected into the affected vein, causing it to collapse, seal, and eventually fade.
• Ideal for treating small to medium-sized varicose veins and spider veins, often requiring multiple sessions.

Endovenous Laser Therapy (EVLT)

• A catheter-based procedure that delivers laser energy inside the vein, generating controlled heat that closes and seals the vein wall.
• Used primarily for larger veins, such as the great saphenous vein.
• Offers high success rates, minimal discomfort, and quick recovery with only local anesthesia required.

Radiofrequency Ablation (RFA)

• Similar in approach to EVLT, RFA uses radiofrequency energy to heat and collapse the diseased vein.
• Performed under ultrasound guidance, the procedure is highly effective for superficial venous reflux, especially in the legs.
• Minimally invasive and well-tolerated, it’s often preferred for its low complication rates and excellent long-term outcomes.

Surgical Vein Stripping or Ligation

• A more invasive surgical option where one or more veins are tied off (ligation) and/or removed (stripped) through small incisions.
• Typically reserved for severe or recurrent varicose veins, especially when other methods are not suitable.
• Requires regional or general anesthesia and may involve a longer recovery period compared less invasive alternatives.

Ambulatory Phlebectomy

• A micro-extraction technique that removes visible, bulging varicose veins through very small skin punctures.
• Performed under local anesthesia and is frequently used in combination with EVLT or RFA to optimize both functional and cosmetic outcomes.