Medical guidelines recommend first-line treatments like graduated compression stockings (20-30 mmHg) to improve venous return, along with lifestyle changes such as leg elevation, avoiding prolonged sitting/standing, and regular exercise. Supplements like horse chestnut seed extract (300 mg) can help reduce swelling, pain, and itching. For severe cases, prescription medications or interventions like sclerotherapy, endovenous laser therapy (EVLT), or surgical options may be necessary.
January 10, 2025

Venous Insufficiency and Varicose Veins Management

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Chronic venous insufficiency (CVI) occurs when veins in the legs fail to efficiently return blood to the heart, leading to symptoms like leg swelling, varicose veins, and skin changes. All recommendations are sourced from the American ​​Society for Vascular Surgery and the American Venous Forum:

First-line recommendations:

  • Compression therapy: Wear graduated compression stockings with 20-30 mmHg compressive pressure at least up to thighs to improve venous return. Should be worn long-term all day, every day. Elasticity is lost over time; use two pairs that should be alternated daily and replace after 6–9 months. Popular Unisex Compression Stockings

  • Lifestyle modifications: Elevate legs several times a day and avoid prolonged standing or sitting. Engage in regular exercise to promote circulation. Electric Seated Pedal Exercise Tool.

Supplement recommendations:

  • Horse chestnut seed extract (aescin) was found in 17 randomized controlled trials to be effective in decreasing edema, pain, and itching. Chestnut extract 300 mg tablets.

Prescription medications and intervention:

  • Aspirin or pentoxifylline: May be prescribed to reduce inflammation and improve blood flow in severe cases.

  • Sclerotherapy: Injection of a sclerosant into varicose veins to close them.

  • Endovenous laser therapy (EVLT) or radiofrequency ablation (RFA): Minimally invasive procedures to treat refluxing veins.

  • Surgical interventions: For advanced cases, vein stripping or ligation may be performed.

Citation

Gloviczki, P., Comerota, A. J., Dalsing, M. C., Eklof, B. G., Gillespie, D. L., Gloviczki, M. L., ... & Wakefield, T. W. (2011). The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of vascular surgery, 53(5), 2S-48S.

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