Methods of Varicose Vein Treatment

Overview of Available Treatment Options

This page provides an overview of the methods used to treat varicose veins, explaining how each approach works and when it may be recommended. It is intended for educational purposes and to help patients understand the different procedural options that may be discussed during a vein evaluation.

Varicose vein treatment is not one-size-fits-all. The appropriate method depends on symptoms, ultrasound findings, vein anatomy, and medical necessity. Not all patients require intervention, and not all veins require the same type of treatment.

How Varicose Veins Are Treated

Modern varicose vein care focuses on closing or removing abnormal superficial veins that no longer function properly. These veins allow blood to flow backward (reflux), contributing to pain, swelling, heaviness, skin changes, and visible varicosities.

Treatment methods are minimally invasive, performed in-office, and guided by ultrasound imaging. The deep venous system, which carries the majority of blood flow from the legs, is preserved and never treated.

Conservative (Non‑Procedural) Management

Conservative care may be recommended as an initial step or when procedural treatment is not medically indicated.

Common conservative measures include:

Graduated compression stockings
Regular walking and leg movement
Weight management and lifestyle modification

Conservative management may help relieve symptoms but does not eliminate diseased veins or correct venous reflux.

Procedural Treatment Methods

When medical criteria are met, minimally invasive procedures may be recommended to address malfunctioning superficial veins.

#1 Endovenous Laser Ablation (EVLA)

Also known as Endovenous Laser Treatment (EVLT), EVLA is one of the most effective and widely recommended treatments for varicose veins caused by axial vein reflux.

During this minimally invasive, in-office procedure:

A thin laser fiber is inserted into the diseased vein through a tiny skin puncture
Local anesthetic is injected along the vein, creating a protective “liquid cushion”
Laser energy is delivered to seal the vein shut, permanently removing it from circulation

EVLA provides excellent long-term results with minimal discomfort and rapid recovery.

EVLA Illustration

#2 Ultrasound-Guided Sclerotherapy (Echo-Sclerotherapy)

This technique uses real-time ultrasound imaging to guide injections into varicose veins that are not visible on the skin surface.

An FDA-approved liquid or microfoam sclerosant is injected into the targeted vein, causing it to collapse and gradually be absorbed by the body.

This method is ideal for:

Tortuous or irregular veins
Deeper varicosities not visible under the skin
Hard-to-reach veins not suitable for laser treatment

#3 Compression Sclerotherapy

The most common treatment for reticular veins and spider veins.

Performed using very fine needles
Sensation similar to a mosquito bite
Multiple sessions may be required

Temporary bruising is common. Skin discoloration, if it occurs, typically fades over several months.

Ambulatory (Stab) Phlebectomy

A surgical technique used to remove large, bulging varicose veins through tiny skin openings.

Small punctures usually do not require stitches
Minimal scarring
Immediate cosmetic improvement

While once very popular, this procedure is now used selectively, as many veins can be treated effectively with foam sclerotherapy.

VNUS Closure (Radiofrequency Ablation)

Radiofrequency ablation was introduced in 1999 and predates laser technology. While still used by some physicians, it requires a larger, less flexible catheter.

Due to advancements in laser technology—particularly the 1470 nm diode laser—radiofrequency ablation is no longer offered at our clinic. EVLA provides superior precision, patient comfort, and outcomes for axial vein treatment.

VenaSeal® (Medical Adhesive Closure)

VenaSeal® is an FDA-approved medical adhesive used for vein closure. FDA approval, however, does not automatically mean a procedure is the most appropriate option for every patient.

Published medical literature has reported adverse events associated with cyanoacrylate adhesive vein closure, including inflammatory and thromboembolic complications. As with any medical procedure, risks and benefits must be carefully weighed on an individual basis.

After reviewing available clinical data and considering long-term safety, VenaSeal® is not offered at our clinic. Our treatment recommendations are based on physician judgment, patient safety, and proven long-term reliability.

Reference:
Phlebology: The Journal of Venous Disease, October 30, 2023

Treatment Selection and Staging

Varicose vein treatment is typically performed in stages, beginning with treatment of the primary refluxing veins, followed by reassessment and additional treatment if needed.

The choice of treatment method depends on:

Ultrasound findings
Vein size and location
Symptom severity
Medical necessity and safety considerations

Not all patients require procedural treatment, and not all veins require intervention.

In‑Office Care and Recovery

All procedures are performed in our clinic
Local anesthesia only
No hospital admission
Most patients return to normal daily activities quickly

Individual recovery recommendations vary depending on the procedure and patient factors.

Learn More

Advanced Varicose Vein Care / Chronic Venous Insufficiency – detailed medical explanation of venous disease and staged treatment
Signs & Symptoms of Venous Insufficiency
Before & After Photo Gallery

Medical Disclaimer

The information on this page is for educational purposes only and does not substitute for professional medical advice, diagnosis, or treatment. Treatment recommendations depend on a physician’s evaluation, diagnostic testing, and individual patient circumstances.