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Whatever the chosen treatment, a healthy lifestyle is always recommended: avoid prolonged standing or sitting, avoid tight-fitting clothes, avoid heels that are too high or too flat, avoid prolonged exposure to heat sources such as the sun, avoid a sedentary lifestyle, avoid excess weight and take regular active walks.
Walking favours venous return by activation of the venous muscle pump which compresses veins in the sole of the foot.
The venous muscle pump

Other possible treatments

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If EVLT is considered today as the gold standard or reference in varicose vein treatment, other techniques can be practised. A
Duplex scan
examination allows the most appropriate treatment to be determined for each patient. Depending on the diagnosis, and according to the stage of the disease, alternative or complementary treatments are prescribed: surgery, Closure®, foam sclerotherapy...

Traditional surgery

StrippingLarge varicose veins (saphenous and perforating veins) can be treated with traditional stripping or cryo stripping surgery: this technique requires a short-term hospitalisation (12 to 48 hours), and a general or epidural anaesthesia, and very rarely a local anaesthesia. Since it is an open-surgery procedure, it leaves scars. It also requires time off work with a median of 3 weeks.
This surgical technique gives short-term results similar to EVLT but is less effective in the long term, with
recanalizations
along the same vein in between 30% and 50% of cases at 5 years depending on case studies.
 
Other surgical techniques do exist but are used less frequently (
CHIVA
,
Muller´s phlebectomy
sometimes combined with a
crossectomy
, isolated crossectomy).
  

Other endovenous techniques

  • Radiofrequency or Closure® is close to EVLT in its technique (endovenous thermal burning resulting from a temperature increase similar to EVLT), in its aim (obtaining a definitive
    fibrosis
    of the varicose vein), and in its results (no or few recanalizations in the long term). The technique is also performed under local anaesthesia by
    tumescence
    , and leaves no scar. The after effects are fairly similar to those of EVLT and side effects are identical. However, the procedure is equally long or longer, rather more expensive and, above all, it does not provide as many therapeutic possibilities as EVLT (treatment of varicose veins of small or very large diameter, tortuous varicose veins, and shorter segments such as
    perforating veins
    ).
    Like EVLT, radiofrequency has been practised since the late 90s. The latest technique, Closure® Fast, does not use radiofrequency as a heat source and has not been practised for as long as EVLT.
  • Foam sclerotherapyFoam sclerotherapy aims to chemically burn the
    tunica intima
    in order to reduce the diameter of the varicose vein and obtain its complete fibrosis. It consists in injecting a sclerosing substance in the form of foam under ultrasound guidance. It is performed in at the doctor's office, without hospitalisation, without incision and therefore without scar, and without time off work. It can require several
    outpatient sessions.
    It is not very expensive and has side effects similar to EVLT or Closure® but often of a shorter duration.
    Its effectiveness in a first-line treatment of saphenous veins (as an alternative to surgery, laser or Closure®) is less effective in terms of immediate as well as long-term results at 5 years with frequent recanalizations. However, this technique gives excellent results as a second-line treatment, that is to say as a complement to EVLT, surgery or Closure®. During an annual
    phlebologic
    check-up, this technique allows laser or surgical revisions to be avoided in already treated areas in the vast majority of cases.
  • An endovenous technique using water steam, with the same aim as the endovenous laser (thermal burning), is a very recent development and is currently under evaluation.

Symptomatic treatments

  • Venotonics are analgesic drugs that do not cure venous disease and its consequences. At most, they can reduce the symptoms felt (heaviness, pain,
    restless legs syndrome
    ,
    paresthesia
    ).
  • Compression tights, stockings or bands limit and ease the development of symptoms, like venotonics. Contention probably limits the evolution of venous disease but, like venotonics, it does not prevent long-term complications and in particular skin disorders.
 

3 points to remember

Traitement des Varices par Laser Endo-Veineux (LEV)A Duplex scan is indispensable in order to make a proper diagnosis and to determine the appropriate therapeutic indication.

Traitement des Varices par Laser Endo-Veineux (LEV)An annual Duplex scan and clinical examination is essential whatever the initial technique chosen.

Traitement des Varices par Laser Endo-Veineux (LEV)Proper treatment and follow-up of varicose veins may prevent many complications, which may be irreversible.


























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