Outpatient

• Conservative methods
  • Frequent rest periods with legs elevated
  • Lightweight, elastic compression hosiery. Best put on before getting out of bed.
  • Avoid girdles and other restrictive clothing
  • If stasis ulcers present, use warm, wet dressings
• Spider veins (idiopathic telangiectases)
  • Fine intracutaneous angiectasis
  • May be extensive/unsightly
  • Eliminate with intracapillary injections of 1% solution of sodium tetradecyl sulfate (or hypertonic saline 23.4%) using a fine-bore needle
  • Subsequent treatments may be required until optimal results attained

• Surgical and other methods
  • If there is pain, recurrent phlebitis, skin changes, or for cosmetic improvement for severe cases
  • Ligation and stripping of the saphenous vein
  • Injection of sclerosing solution
  • Stab evulsion phlebectomy - newer procedure with shorter recovery time
  • For extensive fibrosis - excision of the entire area, followed by skin graft may be necessary

• Avoid long periods of standing
• Appropriate exercise routine as part of conservative treatment
• Walking regimen after sclerotherapy is important to help promote healing
• Apply elastic stockings before lowering legs from the bed
• Never sit with legs hanging down

• No special diet
• Weight loss diet recommended, if obesity a problem

• Inform patients that the surgery or sclerotherapy may not prevent development of varicosities and that the procedure may need to be repeated in later years
• For patient education materials favorably reviewed on this topic, contact: National Heart, Lung & Blood Institute, Communications & Public Information Branch, National Institutes of Health, Building 31, Room 41-21, 9000 Rockville Pike, Bethesda, MD 20892, (301)496-4236