What treatments are effective for varicose veins?

For larger trunk varicose veins, as in the saphenous vein, therapeutic options include conservative measures (such as leg elevation and compression stockings), injection sclerotherapy, and surgical vein ligation, with or without stripping.Long-term outcomes appear superior with surgical treatment. For mid-sized reticular veins and spider telangiectasias, several options are available, including sclerotherapy, laser ablation, and thermal ablation. However, no randomized trials have compared the relative effectiveness of these treatments. Venotonic medications (primarily plantderived and synthetic flavonoids, such as horse chestnut seed extract, that improve venous tone) provide symptom relief. Head- to-head comparisons are needed to identify the most efficacious therapies (strength of recommendation: C, based on case series and extrapolations from small trials.