Varicose veins in Naples: diagnosis and personalised treatments

At our Centre, treatment of veins and spider veins on the legs requires a prior consultation and colour duplex ultrasound scan of the leg veins carried out personally by Dr Ciro Gargano, the same doctor who will perform the treatment. The doctor chooses the method after assessing the individual case. Continuity between diagnosis and treatment is the basis of our care pathway.

No. They can be asymptomatic, but in some people they are associated with heaviness, pain, swelling, cramps, itching, skin changes, thrombophlebitis, bleeding or venous ulcers. A specialist assessment helps distinguish the aesthetic problem from the functional one and situations that require treatment from those that can be monitored.

No. There are conservative, sclerotherapy, endovenous and surgical options. Many varicose veins can be treated with minimally invasive techniques, avoiding traditional surgery. The choice depends on the clinical indication and the colour duplex ultrasound findings and cannot be established correctly without assessing the individual case. In some patients, clinical monitoring may be sufficient.

No. Compression can help control swelling, heaviness and other symptoms of venous insufficiency, but it does not eliminate existing varicose veins. Stockings may be recommended before or after treatment or when there is no immediate indication for a procedure. The type of stocking and the compression class must be chosen after a specialist assessment.

Yes. Even after a correctly performed treatment, varicose veins can reappear over time. This phenomenon, called recurrence, is possible with any therapeutic method, whether surgical or minimally invasive.

However, it is important to distinguish between the successful treatment of the treated vein and the appearance of new varicose veins over the years due to the natural progression of venous disease.

The real question is not whether a recurrence might occur, but how likely it is and after how long. For this reason, in the evaluation of results, we consider the percentages of patients who maintain a good clinical and instrumental outcome years later. Techniques such as endovenous radiofrequency and ultrasound-guided sclerotherapy may be indicated in selected cases, based on the clinical picture and the colour duplex ultrasound. Expected benefits, limitations and the risk of recurrence are discussed during the consultation.

Correct follow-up and, when indicated, some simple preventive measures (weight control, physical activity, use of compression stockings in recommended cases and periodic checks) contribute to reducing the risk of new manifestations of venous disease.

For this reason, it is not correct to promise the absolute absence of recurrence.

In most cases, varicose veins do not directly cause deep vein thrombosis, but they can favour the appearance of superficial thrombophlebitis, i.e. inflammation of a varicose vein associated with the formation of a thrombus. In the presence of sudden pain, redness or significant swelling of a leg, promptly request a medical assessment: a venous colour duplex ultrasound may be necessary. If breathing difficulties or chest pain also develop, call 112 or 118.

Not every dilated saphenous vein needs treatment. The indication depends on venous reflux documented by colour duplex ultrasound, the patient’s symptoms and the vein’s anatomy. When reflux is significant and causes varicose veins, swelling, pain or skin changes, minimally invasive treatments such as endovenous radiofrequency or ultrasound-guided foam sclerotherapy may be indicated in selected cases.

Endovenous radiofrequency is a minimally invasive procedure that is generally well tolerated. It is performed under tumescent local anaesthesia and allows the saphenous vein to be treated without extensive surgical incisions. In most patients, post-procedure pain is modest and the return to normal daily activities occurs quickly.

Sclerotherapy allows the treated veins to be closed, but it cannot prevent the natural evolution of venous disease. For this reason, it is possible that new varices may appear in other areas over time. Diagnosis with colour duplex ultrasound guides the choice of technique; periodic check-ups allow the outcome to be evaluated over time and the possible need for further treatments.

Yes. Walking is one of the most useful activities for encouraging blood return to the heart, because the contraction of the calf muscles acts as a real “venous pump”. Regular physical activity helps reduce heaviness, swelling and venous pooling. However, when significant venous insufficiency or a saphenous vein with reflux is present, walking alone does not eliminate the problem: it is important to combine it with a colour duplex ultrasound assessment to determine if specific treatments such as sclerotherapy or radiofrequency are indicated.