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.

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, you may want to have surgery or another procedure. If your main concern is how your legs look, you might consider a procedure. 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.

• External 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. This laser treatment is used on the outside of the skin to close off small veins near the surface.
• Endovenous ablation. Endovenous means that the procedure is done inside the vein. Ablation means a doctor uses something to damage and close off the vein. A doctor inserts a tube into a vein through a small cut in the skin. The doctor may use heat, chemicals, or a small wire to slightly damage the vein. Scar tissue forms and closes the vein. Or a special glue may be used to close the vein.
• Sclerotherapy. A chemical is injected into the varicose vein to damage and scar the inside of the vein. This closes the vein.

Phlebectomy (also called microphlebectomy or stab avulsion) is usually done along with another procedure or surgery to treat varicose veins. Several tiny cuts are made in the skin. The veins are removed through these cuts. Stitches usually aren't needed.

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 may be asleep during the surgery, but it also can be done while you are awake. If you are awake, you will get medicine to numb your leg and prevent pain. You'll probably have a few stitches.

Most treatments for larger veins seem to work about the same to close varicose veins. Endovenous ablation treatments appear to work a little better than surgery. And endovenous ablation and surgery appear to work better than sclerotherapy.^{footnote 1}

Endovenous ablation using laser or radiofrequency heat works in more than 96 out of 100 people. These treatments may not work for fewer than 4 out of 100 people.^{footnote 1}

Surgery works in about 90 out of 100 people. It may not work for about 10 out of 100 people.^{footnote 1}

Sclerotherapy works in more than 70 out of 100 people. It may not work for up to 30 out of 100 people.^{footnote 1}

All of these treatments appear to work about the same to:

• Relieve symptoms.
• Improve the look of the skin.
• Improve quality of life.

Studies show that all of the treatments have a similar risk that the varicose veins may come back.^{footnote 1}

Endovenous ablation and sclerotherapy have some risks. But problems that need treatment are not common.

Here are examples of risks:

• Blood clots may form in the veins.
• You may have small scars.
• 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. But problems that need treatment are not common.

Examples of 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.

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.