What to Know About Treatment for Varicose Veins

“As we age, the outer lining of our veins, especially those close to the skin’s surface, become weaker from many factors, including sun exposure,” explains San Diego dermatologist Mitchel P. Goldman, M.D., author of Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins. Wear and tear on a vein’s valves over the years also contributes.

How are they treated?

Depending on the severity of your situation, your doctor may recommend trying a few things at home before moving on to other interventions.

Elevating the legs, avoiding prolonged standing, and wearing compression stockings to keep the blood moving can provide relief from symptoms and might even prevent them from getting worse, according to guidelines published in the journal American Family Physician. And although the evidence is far from conclusive, a review of studies published in the Cochrane Database of Systematic Reviews suggests that phlebotonics, a class of drugs made from plants and similar synthetic compounds, may improve blood circulation.

To get rid of varicose veins, however, your health care provider may suggest one of the following.

• Laser therapy and pulsed light therapy. With these in-office treatments, your doctor uses high-intensity laser beams or intense pulsating light to damage the inside of the vein, causing it to collapse. (Don’t worry: Blood flow from destroyed or removed veins is naturally redirected to other healthy veins nearby.)
• Sclerotherapy. Another outpatient treatment, this approach involves injecting liquid or foam into the affected vein to close it off. A recent study in the journal Phlebology suggests that a combination of sclerotherapy and another type of treatment called radiofrequency thermocoagulation — which uses heat to destroy tissue — provides better cosmetic outcomes than sclerotherapy alone.
• Surgery. For people with severe or stubborn varicose veins that don’t respond to the treatments above, surgical procedures such as phlebectomy (where smaller varicose veins are removed by way of tiny skin punctures) or vein stripping (when two incisions are made on the leg and the entire vein is then pulled out through an incision near the groin) may be needed, Lyons says, “although this can be uncomfortable and cause minor scarring.”

If you have heart or vascular disease, be sure to tell your physician before undergoing treatment for varicose veins. One vein commonly destroyed during treatment is the great saphenous vein, Lyons points out. And while this vein can be safely removed to treat varicose veins, it’s often used in bypass surgeries, so it should not be removed if there is a high chance you will need it in the future, he says.

It’s important to keep in mind, too, that “most insurance providers require a trial of compression therapy (wearing compression stockings) before more invasive medical options can be considered,” Lyons says. What’s more, insurance coverage is more likely to be approved if your varicose veins aren’t just a cosmetic concern but are causing pain, swelling or other symptoms.

When it comes to recovery, nonsurgical treatments tend to have faster recovery times than surgery, and complications — like numbness, skin ulcers, and bruising or tenderness — are relatively low.

Patients who opt for vein ablation or phlebectomy may have to wear compression stockings following the treatment and could experience some tightness or discomfort for a few weeks, Lyons says.

Is it okay to skip treatment? 

That depends. Varicose veins aren’t typically associated with serious health risks, but since they can cause your legs to cramp or swell, they can do a number on your quality of life, affecting everything from what you wear to how you go about accomplishing daily tasks like grocery shopping. “Usually we treat varicose veins when patients have symptoms,” Ting notes.

For a small number of people with varicose veins, the condition places them at significant risk for vascular diseases such as deep vein thrombosis, which occurs when a blood clot forms in one or more of the body’s deep veins, usually in the legs. If you’re among this extreme minority, your doctor will likely suggest you undergo the treatment for varicose veins that’s best for you.