Varicose veins: Should I have a surgical procedure?

Varicose veins are twisted, enlarged veins near the surface of the skin. They are most common in the legs and ankles. You may have them in one or both legs.

They can make your legs ache, hurt, itch, and swell.

Even if you don't have symptoms, you may not like the way the veins make your legs look.

See a picture of varicose veins.

You can treat varicose veins with home care, surgery, or another procedure.

Home treatment

For many people, home treatment relieves pain and other symptoms. If you don't have serious problems from varicose veins, home care may be all that you need. But home treatment won't make your varicose veins go away or look better.

You can:

• Wear compression stockings.
• Prop up your legs on a pillow or a chair when you can.
• Exercise to improve blood flow in your legs.
• Lose weight if needed. (Being overweight can make varicose veins worse.)

If you still have pain or other symptoms after trying home treatment for 6 to 12 months, you may want to have surgery or a procedure. If your main concern is how your legs look, you could have treatment whenever you want. Home care won't change how your legs look.

Procedures for varicose veins

These less invasive procedures close or remove the varicose veins. They can usually be done in your doctor's office or clinic.

• Sclerotherapy. A chemical is injected into the varicose vein to damage and scar the inside of the vein. This closes the vein.
• Laser treatment. A laser is a highly focused beam of light. Heat from the laser damages the vein and causes scar tissue, which closes the vein. Lasers may be used:
  • On the outside of the skin (external laser) to close off small veins near the surface.
  • Inside a vein (endovenous laser) to close large veins. The doctor places a thin tube called a catheter into the vein through a small cut in the skin.
• Microphlebectomy, or stab avulsion. Several tiny cuts are made in the skin. The veins are removed through these cuts. Stitches usually aren't needed.
• Radiofrequency closure. This procedure uses a type of energy that is different from that of a laser to close off large varicose veins in the legs. A small cut is made in the vein. The energy is directed through a thin tube placed in the cut.

Surgery for varicose veins

Vein ligation and stripping is a surgical treatment for varicose veins. One or more cuts are made over the vein, and the vein is tied off (ligated) in two places. All or part of the vein between the tied off areas is usually removed (stripped). You'll need general or spinal anesthesia for this surgery. You'll probably have a few stitches.

The less invasive procedures to treat varicose veins appear to work as well as surgery. But these procedures are relatively new and long-term results are not known yet.

• Sclerotherapy can reduce symptoms and improve the look of the skin. It works in about 80 out of 100 people. It doesn't work for about 20 out of 100 people who have the procedure.¹
• Endovenous laser treatment closes veins about 94 out of 100 times. It doesn't work about 6 out of 100 times.¹
• Microphlebectomy, or stab avulsion, is less likely to fix varicose veins when the leg veins are not working well. Because that is the case for most varicose veins, this procedure is usually used along with vein surgery or less invasive procedures..
• Radiofrequency closure works well in about 85 out of 100 people who have it. That means it doesn't work well in 15 out of 100 people.¹
• Vein ligation and stripping removes varicose veins and keeps them from coming back in 90 out of 100 people. It doesn't work for 10 out of 100 people.²

Sclerotherapy, endovenous laser treatment, and radiofrequency closure have some risks:

• Varicose veins may come back. This is fairly common.
• Blood clots may form in the veins.
• You may have small scars.
• Your skin may be numb where the thin tube is put in for radiofrequency closure or endovenous laser treatment.
• You could have bleeding sores.
• You could have an allergic reaction to the liquid that is put into the vein during sclerotherapy. This is rare.
• The color of your skin could change and stay that way, or tiny new blood vessels could form in the area that was treated. These problems are rare.

Vein ligation and stripping also has some risks:

• You could bleed a lot.
• You could get an infection.
• You might have numbness in your legs.
• You could have small scars where the vein was removed.
• You could have problems from anesthesia.

People who have had blood clots in a deep vein (deep vein thrombosis) or blood clots and inflammation in a small vein near the surface of the skin (thrombophlebitis) may be at greater risk for problems from surgery for varicose veins.

Your doctor might suggest surgery or a procedure if:

• You have tried compression stockings and other home care and you still have pain and swelling.
• You want to treat varicose veins so that your legs will look better.