Medicare and many insurance companies have designated that wearing compression stockings for a set period of time (usually 3-6 months) is a prerequisite before other types of varicose vein treatments will be considered and/or approved.

It must be emphasized that compression stockings therapy is not a cure for vein related issues such as varicose veins, non-functioning valves in the veins, swelling from pooling of blood or simply cramping, pain and heaviness in the legs from increased venous pressure.

For many patients, daily wearing of graduated compression socks, stockings or pantyhose can bring great relief from the above stated symptoms.  However, it does not resolve the underlying “defects” affecting the veins.

Curiously varicose veins that occur during pregnancy often will actually improve without medical treatment within 12 months after giving birth.  Unfortunately, women who did get varicose veins during their pregnancy will likely see them recurring with greater severity during each subsequent pregnancy. This is why compression stockings should be recommended by their physician if there are no contraindications.

It is rather interesting to note that the requirement of wearing compression stockings prior to authorizing a vein procedure is not based on any scientific research or testing whatsoever.  In addition, there is no evidence or research suggesting that wearing compression stockings for a set period of time before a medical procedure would improve the outcome.

This could easily lead one to conclude that such a constraint is merely imposed by insurance providers to give patients the run around and/or try to deter them from having more costly medical procedures performed.

Available Medical Procedures After Compression Stockings “Trial Period”

If you have successfully gone through the required “trial period” of compression stockings and would like a potentially more permanent solution to your vein problems you can discuss the following options with your physician and/or a vein specialist:

1. Sclerotherapy – This is considered the most common treatment for spider veins and varicose veins.  During the procedure a chemical solution is injected into small and medium sized veins, which causes the vein walls to fuse together and close up.  The vein turns into scar tissue and the varicosity should fade away.  Veins may need to be injected more than once and the procedure does not require anesthesia.  The patient is usually asked to wear compression stockings for several weeks after the treatment to decrease any swelling.

Side effects can include stinging, redness or bruising where the injection was made. This all usually disappears on its own shortly after the treatment. The occurrence of spots, brown lines, or groups of fine red blood vessels around the treated vein will also normally go away shortly after treatment. In some cases lumps of blood can get trapped in a vein and cause inflammation. Your doctor can drain the trapped blood with a small pinprick during a follow-up visit.

2. Laser Treatments – New laser technology is being used by doctors to effectively treat and close off spider veins and smaller varicose veins. Laser surgery sends high intensity bursts of light through the skin and onto the vein, which makes the defective vein slowly fade and disappear.  It should be mentioned that not all skin types and colors can be safely treated with laser surgery.

Side effects of laser treatments can include redness or swelling of the skin immediately following treatment; however this will disappear within a few days.  Discoloration of the skin will usually fade within 1-2 months.  In rare cases the patient may experience some burns and scars from poorly performed laser surgery.

3. Endovenous Techniques – These methods have replaced surgery for many individuals with certain types of varicose veins, such as varicosities of the saphenous veins.  They are usually performed in the doctor’s office.  For example, in one of these treatments the doctor puts a thin tube called a catheter into an enlarged vein. He then heats up the tip of the device and as the catheter is pulled out of the vein the heat causes the vein to collapse and seal shut.  The symptoms caused by the varicose veins improve and healthy veins around the closed up vein take over the return flow of blood to the heart.

4. Surgical Ligation and Vein Stripping – Surgical treatment is usually reserved for very large varicose veins.  During surgery the vein(s) involved are tied shut and then completely removed from the leg through small incisions in the skin. This surgery requires general anesthesia and must be performed in an operating room.  The recovery time for this type of procedure is 1-4 weeks.

The most common side effect of vein surgery is usually pain in the affected leg.  Other side effects can include heart and breathing related issues from the anesthesia as well as bleeding and congestion of blood. However, the collected blood usually resolves on its own and does not require any further treatment. Additional issues include redness, inflammation, swelling, and wound infection, as well as possible permanent scarring.

Other unpleasant side effects can be damaged nerve tissue around the treated vein, which can cause numbness, burning, or a change in feeling around the scar.  Unfortunately it seems to be hard to avoid harming small nerve branches when veins are removed.

In rarer cases surgery can cause a deep vein blood clot. These clots can pose a risk of travelling to the lungs and heart where they could cause a pulmonary embolism. Blood thinner medication may be given to reduce the chance of these dangerous blood clots.  However, this can also increase the normal amount of bleeding and bruising after surgery.

5. Ambulatory Phlebectomy – With this procedure small cuts are made in the skin and hooks are used to pull the defective vein out of the leg.  The leg will be numbed in the areas where it will be pricked.  Scarring is said to be minimal with this procedure and most individuals can return to their normal activities one day after the treatment.

6. Endoscopic Vein Surgery – This type of operation is usually only performed in cases of advanced leg ulcers.  During the procedure the surgeon utilizes a tiny video camera inserted in the leg to see and close the varicose veins.  He then removes the veins through a number of small incisions.  The entire surgery is performed on an outpatient basis.

Be Vigilant as a Patient

As with any major decisions, caution should be applied when deciding a treatment option for varicose veins.  Make sure you have signs or symptoms that meet the requirements of your insurance carrier to cover treatment.  Discuss any potential health risks and side effects with your physician and vein specialist before having any procedure.

Be careful of claims that offer “painless” and “permanent” solutions to remove varicose veins.  The truth is varicose vein and spider vein treatments are effective but it is also possible that varicose veins can reoccur.  Spider veins are considered a cosmetic issue by most insurance carriers and are therefore not covered for treatment.

Quick Tips for Choosing and Purchasing Compression Stockings

• You will find it most practical to have 2 pairs of compression stockings.
• You will normally need 20-30 mmHg compression stockings or pantyhose for the 3-6 month compression stocking trial before and after your phlebectomy and also if you are having sclerotherapy.
• The compression stockings must be thigh-high or pantyhose with open or closed toe design. In some cases knee highs are okay too if approved by your healthcare provider.
• Make sure that the staff at the medical supply store measures your legs correctly and orders the correct size. Make an early morning appointment for measuring before your legs get a chance to swell.
• After you are finished with your procedure and recovery period, you may no longer need to wear the heavier support stockings.
• It is often recommended to wear lighter compression stockings of 8-15 mmHg on a daily basis and when you travel.  This can help decrease the occurrence or progression of other varicose veins, spider veins and blood clots.

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