2017 HCHB_digital

Varicose Veins and Support Stockings
Varicose veins are large dilated blood vessels that have a red or bluish colour
and protrude above the surface of the skin. Most people use the term varicose
veins to describe veins in the legs but they can occur elsewhere on the body.
When situated in the leg they can ache or throb, and cause cramp or leg swelling.
Very small veins in the skin are called thread veins or spider veins and,
although they cause fewer other symptoms, they may be more difficult to treat
(see Bruises, Scars and Spider Veins).
Varicose veins are usually caused by an incompetent valve system allowing
blood to return into the superficial layers just beneath the skin. The resultant
increase in pressure in these thin-walled skin veins can then cause vein
enlargement and further valve failure. Varicose veins are usually hereditary and
occur more often as people age. The risk is also higher in people who stand all
day on hard surfaces, in pregnant women and in people who are obese.
Initial assessment
Varicose veins are best diagnosed by a doctor, as they may signal other circulatory
problems or harbour blood clots. A doctor will conduct a physical exam and use
other tests, such as an ultrasound, to determine valve functioning.
For customers wanting flight socks, check they do not have any circulatory
problems (such as diabetes), and that they have the physical capability to pull on
the socks. Refer any customers with "yes" answers to the Refer to Pharmacist
questions to a pharmacist.
Treatment of varicose veins
Support stockings (also called compression stockings) remain an important
treatment for varicose veins. These stockings provide a graduated compression,
which helps direct blood flow back from the lower leg to the heart. Compression
is firmest at the ankle and gradually reduces as the distance from the ankle
increases.
Long-term use of support stockings is recommended, even after leg vein
surgery, to prevent varicose veins from returning. Graduated compression
stockings cannot cure varicose veins but can prevent further vein deterioration.
Compression hosiery/stockings can be used:
• after leg liposuction
• after treatment of spider or varicose veins
»»
Treatments for varicose veins include Endovenous Laser Ablation (EVLA),
Ultrasound Guided Sclerotherapy (UGS) and surgery.
• as flight socks (grade 1 compression only) to help prevent deep vein thrombosis
(DVT) on long-haul flights or prolonged car travel
• to help symptoms of varicose veins.
Advice for customers
• Measurements may be required to fit the person with the correct size of
stocking. Class 1 stockings do not require fitting, while classes 2 to 4 must
have measurements taken for a correct fit, and can be sold only on the
TREATMENT OPTIONS
Category Examples Comments
Graduated compression
hosiery
Other products
Natural / herbal products /
supplements
eg, Encircle Merino, Jobst range, Mediven range,
Scholl Flight Socks, TGX Socks, Venosan
[GENERAL SALE]
eg, mucopolysaccharide polysulfate (eg,
Hirudoid)
Butcher’s broom, horse chestnut (Venotrex),
gotu kola, grape, nattokinase, pycnogenol, sweet
clover
Support hosiery is classified into four different grades of compression: Class 1 may be sold in
pharmacies and without a doctor’s recommendation. Classes 2 to 4 may be sold only on the
recommendation of a doctor.
Grade/class 1 compression is recommended for people with tired, aching legs, mild varicose
veins, mild ankle swelling and to prevent ankles and feet swelling during long flights, eg,
Scholl Flight Socks.
Grade/class 2 compression is used for people with moderate-to-severe varicose veins,
pronounced ankle swelling after vein surgery, and to prevent recurrence of venous leg ulcers.
Grade/classes 3 and 4 compression hosiery is used for people with severe varicose veins or
ankle swelling, active leg ulcers and to prevent leg ulcers recurring. These would probably be
recommended by a specialist.
Full-length hosiery – stockings or pantyhose – are usually preferred for people with varicose
veins in the thigh, and for pregnant women.
Knee-high support stockings provide enough support for people with lower leg problems, eg,
varicose veins, swollen ankles and ulcers.
It is important to fit people with the correct size, according to the properly taken
measurement.
Contains enzymes that help disperse excess fluid in swollen areas. They reduce swelling and
bruising. Can also be used as a treatment following sclerotherapy.
There is some evidence for the benefits of horse chestnut, butcher’s broom, grape,
pycnogenol, and sweet clover in chronic venous insufficiency and for the improvement in
symptoms of varcose veins. Gotu kola, nattokinase or pycnogenol may decrease the risk of
DVT related to long-distance travel.
Page 162 HEALTHCARE HANDBOOK 2017-2018 Common Disorders