How Are Varicose Veins Treated?

Goals of Treatment

The goals of treating varicose veins may include easing symptoms, avoiding complications, and improving cosmetic appearance. Although treatment can target existing varicose veins, it can't keep new varicose veins from forming.

Who Needs Treatment

Varicose veins that cause few signs and symptoms usually don’t need to be treated. Instead, your doctor may recommend simple self-care measures. Varicose veins causing more severe signs and symptoms may need medical or surgical treatment. Treatment may be recommended when the varicose veins are causing skin ulcers, serious skin conditions, blood clots, significant pain, or disruption of daily life activities. Some people with varicose veins may choose to have medical or surgical treatments to improve the cosmetic appearance of varicose veins.

Types of Treatment

Self-Care Measures

Self-care measures are a common option for treating varicose veins. If self-care measures are called for, your doctor may ask you to:

• Avoid excess amounts of standing when possible. Take frequent breaks during prolonged periods of standing.
• Elevate your legs when sitting, resting, or sleeping. Elevating your legs above the level of your heart is very important.
• Wear compression stockings. These are typically worn all day long. Doctors may prescribe special-strength stockings or over-the-counter support stockings, which may be available at pharmacies and medical supply stores.
• Exercise. Exercise gets the legs moving and improves muscle tone, which helps the circulation of blood through your veins.
• Lose weight. Taking off extra pounds may help with blood circulation and pressure on your veins.
• Avoid wearing tight clothes. Tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs, can make varicose veins worse.

Medical and Surgical Treatments

Medical and surgical treatments are used to either remove varicose veins or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins. These therapies range from approaches that don’t involve incisions or injections to those that are surgical procedures. It may be necessary to combine therapies, depending on your condition and lifestyle.

Sclerotherapy. This procedure uses a liquid chemical to close off the vein. The solution is injected into the vein to cause irritation and scarring inside the vein, which causes the vein to close off and fade away. It’s usually used to treat smaller varicose veins and spider veins. Sclerotherapy is usually done in the doctor’s office, while you stand. You may need several sclerotherapy treatments to close off a vein completely. In this case, treatments are typically given every 4 to 6 weeks. Following treatments, your legs are wrapped in elastic bandaging to help healing and decrease swelling.

Microsclerotherapy. This procedure is used to treat spider veins and other very small varicose veins. It involves injection of small amounts of a liquid chemical using a very fine needle. The chemical causes scarring in the inner lining of the veins, causing them to close off.

Laser surgery. This procedure uses no incisions or injections. Light energy from a laser is used to make the vein fade away. Laser surgery is typically used to treat smaller varicose veins. With new technology, lasers are more effective than they used to be.

Endovenous ablation therapy. This procedure uses an energy source (either laser or radiowave) to create heat to close off the vein. A tiny incision is made in the skin, and a small catheter (tube) is inserted into the vein. A device at the tip of the catheter heats up the inside of the vein, which causes it to close off. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home on the same day. You may experience less pain and recover more quickly with this procedure than with some of the others.

Endoscopic vein surgery. This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins. Endoscopic vein surgery is currently only used in severe cases in which there are skin ulcers due to the varicose veins. Only small incisions are required for this procedure.

Ambulatory phlebectomy. In this procedure, small varicose veins are removed through small incisions in your skin. Ambulatory phlebectomy is typically used to treat varicose veins close to the surface of the skin. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home the same day.

Vein stripping and ligation. In this procedure, veins are tied shut (ligation) and removed (stripping) through small incisions. The procedure is typically used in severe cases, in which the varicose veins cause pain or skin ulcers. You’re given medicine to sleep so that you don’t feel any pain during the procedure.

What To Expect After Treatment

Recovery times vary based on the specific procedure that’s performed. Vein stripping and ligation requires more recovery than most other procedures. Activity is not significantly limited following most other procedures. In fact, walking is often recommended during recovery. Some treatments may require that you wear compression stockings or bandages for a period ranging from a couple days to a few weeks following the procedure.

Common side effects immediately following a procedure may include bruising, swelling, skin discoloration, cramping, and itching. Swelling and skin discoloration may last for several months. Less common side effects include blood clots or nerve damage. An uncommon side effect of sclerotherapy is liquid chemical leaking out of the vein, which could cause tissue damage or ulcers.