Your physician will usually try methods that don't involve surgery first to relieve your symptoms. These may include preventive techniques or the use of compression stockings. If your varicose veins do not respond to this conservative therapy, more active treatment may be required.
Fortunately, new minimally invasive techniques like endovenous laser treatment now allow effective treatment of varicose veins with no hospital stay, no scarring, minimal postoperative pain, and nearly immediate relief from your symptoms.
Conservative Management (Stockings). Includes lifestyle changes (exercise, weight loss, elevating legs, avoiding long periods of standing/sitting), and for more severe cases, compression stockings. Elastic stockings will squeeze your veins and attempt to stop excess blood from flowing backwards. You may need to wear compression stockings daily for the rest of your life.
Sclerotherapy. This procedure is the treatment of choice for spider veins or smaller varicose veins. A physician will inject a chemical directly into your vein, causing them to close. These veins will eventually be absorbed by your body. Some stinging or itching at the site of injection may occur.
Endovenous Ablation (e.g. Laser). These minimally invasive procedures offer the latest advance in the treatment of varicose veins and are quickly supplanting surgery as the ‘gold standard'. The fastest growing of these are endovenous laser procedures which offer superior results with minimal side effects. Advantages include:
Designed to be a 45-minute, office procedure
Uses only local anesthetic
High success rate (93-98%)
Lower risk of complications
Fast return to normal activities (normally 1-2 days)
Reimbursable by most health insurance plans
The physician will, using ultrasound, insert a very small catheter into the affected vein (usually below the knee) and advance it up towards the groin. An energy source, (e.g. laser fiber) is inserted through the catheter and fired to cause damage to the internal vein wall, causing it to seal down on itself. The closed vein will eventually be absorbed by the body.
A slightly older version of this technology exists, which uses electrically generated heat delivered via electrodes to achieve a similar effect.
Patients are generally encouraged to walk immediately after the procedure and able to resume normal activities (aside from heavy lifting) the next day.
Surgery (Ligation & Stripping). Use of traditional surgery is decreasing due to the effectiveness of minimally invasive procedures. Surgery can be quite painful, has a long recovery time, and is associated with recurrence rates of 10 to 25 percent. It is generally performed in an operating room, often with general anesthesia, and involves two large incisions at the groin and knee. The vein is tied off, cut, and then stripped (from other attached tributaries) out of the leg. Bruising and swelling often occur post-procedure and nerve tissues surrounding the treated vein can be damaged, causing numbness or burning around the surgical scar.