Varicose Veins: The Least Invasive Treatment Options

Varicose veins are twisted, enlarged, and painful veins that fill with blood. They usually develop in the legs and are raised above the surface of the skin. They aren’t life-threatening but can cause discomfort.

Traditionally, a surgery known as “vein stripping” was performed to remove varicose veins. This procedure involves making small incisions and physically pulling the veins out of the body.

However, more recent technologies remove varicose veins using minimal or noninvasive procedures. A noninvasive procedure is nonsurgical and doesn’t involve tools or equipment that cut the skin or physically enter the body. Minimally invasive procedures are performed by making tiny incisions in the skin.

What are types of noninvasive treatments for varicose veins?

There are several minimal or noninvasive procedures available for treating varicose veins. These include:

Sclerotherapy

The goal of sclerotherapy is to destroy varicose veins by injecting them with a solution called a sclerosant. The sclerosant scars the vein and causes it to collapse, forcing blood to reroute to healthier veins.

Your body eventually destroys the veins, and they disappear over time. One common sclerosant solution is sodium tetradecyl sulfate. This procedure typically treats small varicose veins located close to the surface of the skin, called “spider veins,” and to improve the appearance of the leg.

A procedure called foam sclerotherapy involves turning the sclerosant into foam before injecting it into the vein. This process is used for larger veins because foam can cover a larger surface area than liquid.

Radiofrequency ablation

In this procedure, radio waves, also called radiofrequency energy, are transmitted through the vein wall. Your doctor will numb the vein, use an ultrasound to see inside the leg, and then pass a wire catheter along the vein to apply radiofrequency energy along its wall.

The vein wall will heat up, thicken, contract, and eventually, be reabsorbed by the body and disappear. It may take a few weeks or months to see the full results of this procedure.

Endovenous laser ablation

Laser ablation is similar to radiofrequency ablation, except it uses laser energy rather than radiofrequency energy.

Laser fiber is inserted into the catheter, moved to the necessary location, and laser energy causes the vessel to close by heat. The vein will eventually shrink and be reabsorbed by your body over time. Radiofrequency and laser therapy are often used to treat the deeper veins of the leg.

Phlebectomy

Phlebectomy is another minimally invasive procedure used to treat varicose veins. The doctor makes a small incision near the vein and removes the vein through the incision using a special hook.

This outpatient procedure is done with a local anesthetic, so you would remain awake. It typically takes between 30 and 60 minutes to complete. Some people may need a repeat procedure to get the optimal results.

Who should receive noninvasive treatment for varicose veins?

Not all varicose veins require treatment from a doctor. On your own, you may want to try some lifestyle measures that can help varicose veins:

• exercising
• managing your weight
• elevating your legs while sitting
• wearing compression stockings
• avoiding long periods while standing or seated

Your doctor may recommend noninvasive treatment if:

• self-care treatment isn’t successful
• the appearance of your leg is causing you distress
• you experience any pain or cramping
• blood clots form frequently
• phlebitis (inflammation of the vein) occurs
• ulcers or sores form
• the fatty tissue under your skin hardens due to blood pressure from the vein, which is called lipodermatosclerosis

What can you expect during a noninvasive treatment for varicose veins?

Noninvasive treatment for varicose veins is typically performed in a doctor’s office using a local anesthetic.

Before the procedure

Be sure to tell your doctor if you’re pregnant, have any allergies, or are taking any medications, including any herbal supplements. Your doctor may ask you to stop taking aspirin, blood thinners, or any other medications that make it hard for the blood to clot a few days before the procedure.

During the procedure

You’ll be awake during the entire procedure. Your doctor will use ultrasound to visualize the vein, and clean and numb your leg with a local anesthetic.

You may feel slight pressure when the catheter is inserted or minor stinging if a sclerosant solution is injected into the vein. If they use lasers, you’ll be required to wear protective glasses during the procedure. The closure of the vein, whether with radiofrequency or laser, shouldn’t be painful.

After the procedure

Your legs may be wrapped with bandages to control swelling and bleeding. You may need to wear these bandages for several days.

You should plan on having someone drive you home after the procedure, and you may be advised to avoid strenuous exercise for a week or two after. Acetaminophen (Tylenol) may be recommended for any discomfort, but you should avoid any pain relievers that may disrupt blood clotting, such as aspirin or ibuprofen.

Additionally, your doctor may have you avoid hot baths or whirlpools following the procedure. Cool showers or sponge baths with mild soap and lukewarm water are recommended.

What are the risks of noninvasive treatments for varicose veins?

Noninvasive treatments are generally very safe, however, as with all medical procedures, there are some risks. All the procedures carry risks of:

• allergic reaction to the anesthesia
• bleeding
• bruising
• scarring
• infection

Sclerotherapy

The risks of sclerotherapy may include:

• blood clots
• bruising
• itchy rash
• deep vein thrombosis (DVT)
• discoloring
• mild inflammation or swelling
• nerve injury

Radiofrequency and laser ablation

The risks of radiofrequency and laser ablation include:

• damage to the vessel
• blood clots
• bruising
• hematoma, or a collection of blood outside the blood vessels
• infection
• skin burns
• a sensation of tingling or prickling on the skin
• nerve injury

Phlebectomy

The risks of phlebectomy are:

• discoloring of the skin on the treated area
• infection, though this is rare

What are additional treatments for varicose veins?

If neither home remedies nor noninvasive treatments are able to remove or reduce your varicose veins, your next treatment option may need to be surgery.

Your doctor will likely recommend vein ligation and stripping. In this surgical procedure, the surgeon will tie off all the varicose veins and remove them from the affected leg.

This procedure is typically needed for people who have very large varicose veins. Other reasons to do a ligation include:

• chronic leg pain or discomfort
• bleeding from the veins
• ulcers due to poor circulation in a vein
• damage to the vein

It is typically not an appropriate procedure for:

• older adults who are at higher risk for complications
• people with poor circulation in the leg arteries, or who have swelling due to blocked lymph vessels
• people who have infections in the skin
• people who have any blood-clotting defects
• pregnant people
• anyone with an arteriovenous fistula, which is an abnormal path between the vein and artery in the leg

This procedure may also be conducted as part of a wider treatment that can include home remedies and one of the less invasive procedures. Speak with your doctor to find out which treatment is best for you.

Outlook and recovery process

Typically, you can resume normal activities within a day or two after receiving treatment. You’ll need to wear compression stockings during the day for a week following treatment.

In general, noninvasive procedures are very successful and their risk of complications is low. Typically, these procedures improve the appearance of the skin on the legs or other areas. In most cases, there are no signs of scarring or bruising, but there’s a small risk that the varicose veins may come back. Wearing compression stockings can reduce the risk of the varicose veins returning.

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