Conservative Therapy

Compression stockings are the first line of treatment and conservative vein therapy of patients with varicose veins and other signs and symptoms of venous insufficiency. These symptoms may include diffuse spider veins, swollen achy legs, “French legs”, “piano legs”, thick calves, skin discoloration, and thickening of the skin around the ankles and in the most advanced stages, ulcerations. Compression hose should be specifically measured for the individual patient and generally should not be passed down from generation to generation. They are available in a variety of lengths (knee, thigh, or panty) as well as a variety of colors. Most insurance companies require a trial of compression stocking therapy before one can be considered for more definitive therapy of vein problems.

Insurance requirements
Patients are strongly encouraged to initiate compression therapy as soon as the clinical diagnosis of significant venous insufficiency is either strongly suspected or confirmed on ultrasound. Insurance companies generally require 3-6 months of conservative therapy including compression hose, elevation, weight loss and analgesics prior to patients being eligible for endovenous treatments. There are a number of exceptions to adhering to the conservative trial rule. Exceptions include active ulceration, recurrent bleeding, severe stasis dermatitis with impending bleeding or ulceration or cases in which hose application is not possible (severe debilitating arthritis or upper extremity amputation) in which cases treatment should be performed earlier.

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