Size Matters for the Treatment of Varicose Veins

Varicose veins Chronic venous insufficiency Size Pressure Shunt DiameterVaricose veins are consistent with physically dilated superficial veins ≥3 mm.Physiologically, chronic venous insufficiency is an advanced chronic venous disease with functional abnormalities.Essentially, the shape of the vein is directly influenced by hydrostatic pressure.Ambulatory venous pressure is increased as shunt formation and vein will be dilated by the connection with deep venous refluxes.Hydrostatic parodox in varicose veins is that the ambulatory venous pressure is not directly related with vein diameter but with shunt formation with valve insufficiency.Mean ambulatory venous pressure of 10-30 mmHg is considered as normal, 31-45 mmHg as intermediate and >45 mmHg as severe venous hypertension.Diameter measurement is used in the diagnosis of varicose veins, but treatment need to be more focused to remove hydrostatic pressure rather than diameter of vein in respect to improve symptoms related with varicose veins.Nevertheless, there are some concerns for the treatment of large veins.From the guidelines endothermal ablation is recommended than non-thermal ablation for >10 mm large varicose vein.Large veins might increase the incidence of endothermal heat induced thrombosis.Caprini score more than 7 will be benefited from chemoprophylaxis for large vein.For the compression therapy, inelastic compression is recommended than elastic compression to improve the function of calf muscle pump.