Varicose veins

Treatment for varicose veins

Most varicose veins don’t cause any long-term health problems. You’ll usually only be offered treatment if your varicose veins are causing you discomfort or more serious complications. If you want your veins treated for cosmetic reasons (how they look), you’ll usually need to pay for treatment.

There are several options for treating varicose veins, with the main ones listed below. Your doctor will discuss what is suitable for you. It’s worth considering that whatever treatment you have, there’s a risk that your varicose veins may come back. You may be offered a further procedure if this happens. Ask your doctor what the chance is of this happening.

Endothermal ablation

Endothermal ablation involves using either radio waves (radiofrequency ablation) or a laser (endovenous laser ablation) to seal the affected vein. These procedures can be carried out under local anaesthetic, which means you’ll be awake, but the area around your vein will be numb. Your doctor will make a tiny cut in your vein and insert a fine tube (catheter). They’ll then insert the radiofrequency electrode or laser through the catheter, which will seal off your varicose vein as it’s slowly withdrawn. You’ll usually be encouraged to be up and about afterwards, and go home the same day.

Endothermal ablation is a less invasive alternative to traditional surgery for varicose veins (see below). The treatments work as well as surgery and you’re likely to recover more quickly with less pain, so doctors usually offer these treatments first.You might notice bruising, swelling, or pins and needles after an ablation procedure, but these generally pass quickly.

Foam sclerotherapy

If endothermal procedures are unsuitable for you, your doctor may recommend you have foam sclerotherapy. In this treatment, a chemical foam is injected into your varicose veins. This damages the inside of the veins, causing them to close up. Sometimes you may need more than one injection to block each vein.

Like the endothermal procedures, foam sclerotherapy is less invasive than surgery and can be done under local anaesthetic. Although helpful for some people, foam sclerotherapy may not be as effective as surgery and endothermal ablation.

Side-effects of foam sclerotherapy include headaches, chest tightness, problems with vision, ulcers, and changes to the colour of your skin. There have been rare reports of more serious complications after this treatment too, including heart attacks, seizures, and strokes. These problems may not be linked to the procedure itself, but it’s important to be aware of them.

Surgery for varicose veins

If less invasive procedures are unsuitable for you, your doctor may suggest you have surgery to remove your varicose veins. The most common technique for varicose vein surgery is called ligation and stripping. This is usually done under general anaesthesia, which means you’ll be asleep during the procedure.

Your surgeon accesses the vein via a small cut in your groin. Using special equipment, they’ll tie off the vein (ligation) to stop blood flowing through it. Then, they’ll insert a wire into the vein and pull the vein out through a second cut by your knee (stripping). This removes the vein.

Your surgeon may also remove veins on the surface of your leg using a technique called phlebectomy. This involves your surgeon making small cuts over the veins and using hooks to pull them out. You usually go home the same day after varicose vein surgery, although sometimes you may have to stay overnight.

Surgery is the most ‘tried and tested’ way to remove varicose veins – there’s a lot more long-term evidence to show how well it works compared to other options. But as it involves an operation with general anaesthesia, it does take longer to recover. Your leg may feel sore and uncomfortable for a couple of weeks after your operation

As with any type of surgery, there is the potential for complications, including blood clots and nerve damage, but these are uncommon. Nerve damage may result in reduced sensation in areas of your leg, but this usually gets better with time. It’s also possible that new varicose veins can form later on.

Newer treatments

Sometimes your doctor may suggest newer procedures to treat your varicose veins. These include:

• glue occlusion, which uses a special glue to seal the vein
• mechanochemical ablation, which uses a combination of a wire and a chemical inserted into your vein to close up your vein

There isn’t as much long-term evidence for how well these treatments work, and they may not be available everywhere. Your doctor will tell you if it’s something they’re able to offer.

Compression stockings

If the treatments above aren’t suitable for you, or you decide not to have them, your doctor may suggest you try compression stockings. These can help relieve the swelling and aching in your legs. Your doctor may also suggest compression stockings if you have varicose veins and are pregnant.

If you have a procedure to treat your varicose veins, your doctor may also recommend you wear compression stockings afterwards. Follow your doctor’s advice on how long to wear them for.