What are the recommended first-line treatments for patients with symptomatic varicose veins?

Recommended first-line treatments for patients presenting with symptomatic varicose veins include:

• Referral to a vascular service for assessment with duplex ultrasound to confirm diagnosis and extent of truncal reflux.
• For confirmed varicose veins with truncal reflux, offer endothermal ablation (radiofrequency ablation or endovenous laser treatment) as first-line interventional treatment.
• If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy.
• If foam sclerotherapy is unsuitable, offer surgery (ligation and stripping).
• Compression hosiery should not be offered to treat varicose veins unless interventional treatment is unsuitable; if used, class 2 stockings are preferred but depend on tolerability and patient preference.
• Self-care advice should be given, including weight loss if overweight, light to moderate physical activity, leg elevation, avoiding prolonged standing or sitting, and foot exercises.
• In pregnant women, interventional treatments are generally avoided except in exceptional circumstances; compression hosiery may be offered for symptom relief after excluding arterial insufficiency.

These recommendations aim to relieve symptoms, reduce complications, and improve quality of life in patients with symptomatic varicose veins.

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