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How are varicose veins treated?

Dr. John T. Morris, DO
Vascular Surgeon

Varicose vein treatment is a minimally invasive procedure. All treatments are done in a doctor’s office using local anesthesia to numb the area.

There are three types of varicose vein treatments.

One involves a simple series of injections of medication into the vein. You walk out of the office immediately after the procedure and return to your normal activities.

Another requires tiny incisions to remove the veins. The procedure is used to treat large, rope-like varicose veins. The treatment is still done in a medical office using local anesthesia. It’s quick and any small scars go away very quickly after the procedure.

Sometimes, doctors use heat energy to close the varicose vein. This procedure is called endovenous ablation.

Dr. Celso E. Dias, MD
Vascular Surgeon

Varicose veins can be treated with simple solutions such as compression stockings, exercise, leg elevation and rest. Varicose veins can also be treated with minimally invasive procedures. Smaller varicose veins can benefit from sclerotherapy, in which a solution is injected to close the vein, and larger veins can be sealed off with laser ablation. During this procedure, the vein is treated using catheter-based laser energy. With both treatments, the blood flow is rerouted to healthier veins.

Varicose veins are now treated with laser fibers, which use heat to help diminished the appearance of the vein.

Dr. Michael L. Schwartz, MD
Vascular Surgeon

Treatments for varicose veins depend on the type of vein treated. Smaller varicose veins, also called spider veins, are treated with an injection of medication into the vein. This is called sclerotherapy. Some people may need to have laser or radio-frequency ablation and vein removal.

Most varicose veins can be managed with non-surgical treatment such as compression stockings, which apply a steady pressure to the legs to help the veins and leg muscles move blood efficiently toward the heart. Exercise, elevating the legs when sitting, and avoiding long periods of standing can also help.

Endovenous laser therapy
During this procedure vascular specialists introduce a long, flexible, hollow tube called a catheter into the body through a needle puncture in the groin. The catheter, which is tipped with a laser, is guided to the varicose vein and inserted into it. Laser energy is shone into the interior of the vein, causing the vein to contract. The optical fiber is slowly withdrawn, and the vein closes up behind it.

Sclerotherapy
Sclerotherapy is a simple procedure during which doctors remove small varicose veins. Doctors inject a concentrated saline or other solution into the varicose vein, which irritates the lining of the vein and causes it to close up or collapse. Healthy blood vessels nearby absorb the blood flow of the collapsed vein. Patients usually wear compression stockings or elastic bandages for several days after the procedure.

Traditional Surgery
Vascular specialists may recommend surgical treatment for patients whose varicose veins cause severe aching, infections, or venous ulcers, or whose varicose veins are particularly large or severe or involve large veins in the groin.

Ligation and stripping
Short incisions are made in the skin along the leg, and the varicose veing is tied off, or ligated, by tying a small stitch around it to block blood flow. If only one valve is damaged, the ligated vein may be left in place. If numerous valves are damaged, doctors remove, or strip, the vein by using a special instrument to grasp and remove it. The other veins in the leg take over the work of those that are removed.

Dr. Cheryl H. Hoffman, MD
Vascular & Interventional Radiologist

Treatment for varicose veins involves closing the vein. There are a variety of ways to do this, including the following:

  • Thermal ablation is when doctors apply heat from the middle of the vein to close it off.
  • Phlebectomy is when doctors remove the actual veins, which does not require stitches.
  • Sclerotherapy involves injecting liquid to close the veins.
  • Compression stockings can help, but most people don’t want to wear them daily for the rest of their lives.

Other systems including ClariVein and VenaSeal, and steam-based systems are in development as well.

Varicose veins usually appear as swollen, twisted clumps of blue or purple blood vessels near the surface of the skin in the legs or pelvis. Peter Lawrence, MD, director of UCLA’s Gonda (Goldschmied) Vascular Center, notes that it is important for patients to be evaluated and treated by an expert in venous disease. “There are many new approaches to varicose veins and venous insufficiency. To prevent recurrence, a comprehensive approach is needed,” he notes.

“It’s not just a cosmetic problem,” says Cheryl Hoffman, MD, medical director of UCLA’s Imaging and Interventional Center in Manhattan Beach, who treats superficial varicose veins using minimally invasive techniques. “Varicose veins can be painful.” She continues, “In most cases, we can easily close off problem veins using a catheter to direct laser or radiofrequency energy to heat the inside of the blood vessels.” Ultrasound is used to extensively map the vein physiology and blood flow and to guide the procedure. Unlike more invasive approaches, this technique, called endovenous thermal ablation, causes less pain, bleeding and bruising and enables people with varicose veins to return to normal activities faster.

Treatment options include home remedies and medical treatment. Exercise, weight loss, sitting with your legs above your heart, alternating sitting and standing, and wearing compression stockings are all things you can do at home to treat varicose veins. Medical treatment includes laser or endoscopic surgery, catheter procedures, injections, skin punctures, and vein removal. Be sure to talk to your doctor and insurance company about your options. Some of these options may not covered by insurance.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.