Methods of Varicose Vein Treatment

Treatment Options Available at IVSI

Varicose veins and chronic venous insufficiency can involve different veins, different patterns of reflux, and different levels of disease. For this reason, no single procedure is appropriate for every patient or every abnormal vein.

Treatment selection is based on symptoms, Duplex ultrasound findings, venous anatomy, previous vein treatments, and overall clinical assessment.

At International Vein & Skin Institute, treatment options include endovenous laser ablation, perforator vein ablation, ultrasound-guided liquid and foam sclerotherapy, ambulatory phlebectomy, and sclerotherapy for smaller superficial veins.

The appropriate method — or combination of methods — is selected according to the location, size, anatomy, and pattern of reflux of the veins being treated.

How Varicose Veins Are Treated

Modern treatment of varicose veins and chronic venous insufficiency (CVI) focuses on removing incompetent superficial veins from circulation and redirecting blood through functioning venous pathways.

Different methods are used for different components of venous reflux. Saphenous and accessory veins, incompetent perforating veins, tributary varicosities, and smaller superficial veins may require different treatment techniques.

Treatment is often performed in stages, addressing the primary sources of reflux first and reassessing the remaining venous circulation before additional treatment.

👉 Learn more about Understanding Varicose Vein Treatment

Minimally Invasive Varicose Vein Procedures

#1 Endovenous Laser Ablation (EVLA)

Also known as Endovenous Laser Treatment (EVLT), EVLA is a widely used treatment 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 small skin puncture
Local anesthetic is administered along the vein to provide comfort and protect surrounding tissue
Laser energy is delivered to close the vein

The treated vein is sealed, and blood flow is redirected into healthy veins.

EVLA is associated with durable vein closure and is commonly used for treatment of the great, small, and accessory saphenous veins.

EVLA Illustration
Illustration for educational purposes. Not an actual patient

👉 Learn more about Endovenous Laser Ablation (EVLA)

#2 Percutaneous Ablation of Perforating Veins (PAP)

Percutaneous Ablation of Perforating Veins (PAP) is used to treat incompetent perforator veins that allow abnormal blood flow between the superficial and deep venous systems.

During this ultrasound-guided procedure:

A laser fiber is inserted through a small skin puncture
Local anesthetic is administered around the targeted perforator vein
Laser energy is delivered to close the incompetent perforator vein
Pathologic reflux through the incompetent perforator vein is eliminated

Laser ablation of perforating veins is technically demanding due to the small diameter and variable anatomical location of these veins.

Treatment is recommended only when perforator reflux is clearly contributing to symptoms or advanced skin changes.

#3 Ultrasound-Guided Sclerotherapy (Liquid)

Ultrasound-Guided Sclerotherapy uses real-time ultrasound imaging to guide injection of a liquid sclerosant into targeted varicose veins.

The sclerosant irritates the inner lining of the vein, causing it to collapse and gradually be reabsorbed by the body.

This technique may be appropriate for:

Deeper varicosities not visible under the skin
Residual veins following prior treatment
Smaller tributary veins

Ultrasound guidance allows accurate placement of the sclerosant into targeted veins while avoiding surrounding structures.

👉 Learn more about Sclerotherapy for Varicose Veins

#4 Ultrasound-Guided Foam Sclerotherapy (UGFS)

Ultrasound-Guided Foam Sclerotherapy uses real-time ultrasound imaging to guide injection of a physician-prepared sclerosant foam into targeted veins.

The foam displaces blood within the vein and increases contact between the sclerosant and the vein wall, promoting vein closure and gradual resorption.

UGFS may be used for:

Tortuous or irregular veins
Tributary veins not suitable for thermal ablation
Residual or recurrent varicose veins
Selected axial veins
Incompetent perforator veins

Foam sclerotherapy allows treatment of veins that are difficult to access with a laser fiber or catheter.

Treatment selection depends on vein size, anatomy, ultrasound findings, and overall clinical presentation.

#5 Varithena® (Polidocanol Injectable Microfoam)

Varithena® is an FDA-approved, commercially prepared microfoam formulation of polidocanol used to treat incompetent superficial veins.

Unlike physician-prepared foam, Varithena is manufactured to provide standardized foam characteristics and consistent concentration.

During the procedure:

The microfoam is injected into the targeted vein under ultrasound guidance
The foam displaces blood within the vein and irritates the vein lining
The treated vein collapses and is gradually reabsorbed by the body

Varithena may be considered for:

Incompetent great and accessory saphenous veins
Recurrent varicose veins
Patients in whom thermal ablation is not ideal

Treatment selection depends on vein anatomy, ultrasound findings, prior treatment history, and overall clinical assessment.

#6 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.

👉 Learn more about Sclerotherapy Injections for Spider Veins

#7 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 visual improvement

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

Other Varicose Vein Treatment Methods

Other techniques for treating varicose veins are available in the United States that Dr. Jozef Tryzno no longer uses or does not offer at IVSI based on clinical preference and safety considerations.

Traditional Surgical Vein Stripping

Traditional vein stripping was a standard treatment for saphenous vein insufficiency when Dr. Tryzno began treating varicose veins in 1998.

The procedure involves surgically disconnecting the incompetent saphenous vein and physically removing it from the leg using a vein stripper, typically through surgical incisions.

With the introduction of minimally invasive endovenous techniques, IVSI moved away from surgical stripping. Endovenous ablation allows an incompetent saphenous vein to be closed from within through a small skin puncture, without physically extracting the vein from the leg.

Traditional surgical vein stripping is no longer performed at IVSI.

Radiofrequency Ablation (RFA / VNUS Closure)

Radiofrequency ablation was previously used extensively at IVSI for treatment of incompetent saphenous veins. Like endovenous laser ablation, RFA is a thermal ablation method that uses controlled energy delivered inside the vein to produce vein closure.

With advances in laser technology, IVSI transitioned to Endovenous Laser Ablation (EVLA) as the preferred method of thermal vein ablation. Modern laser technology provides the precision, flexibility, and treatment control preferred in our practice, and radiofrequency ablation is no longer offered at IVSI.

VenaSeal® (Cyanoacrylate Adhesive Closure)

VenaSeal® closes an incompetent vein by placing cyanoacrylate medical adhesive inside the vein.

Although VenaSeal® is FDA approved and can provide effective vein closure, patients should be aware that the adhesive remains within the treated vein. Published medical literature has reported potential complications including inflammatory and hypersensitivity reactions, phlebitis-like reactions, foreign-body granulomas, and glue-associated thrombosis.

IVSI prefers treatment methods that do not leave permanent cyanoacrylate adhesive within the treated vein. Based on these considerations, VenaSeal® is not offered at our clinic.

Reference:
Parsi K, Zhang L, Whiteley MS, et al. 899 serious adverse events including 13 deaths, 7 strokes, 211 thromboembolic events, and 482 immune reactions: The untold story of cyanoacrylate adhesive closure. Phlebology. 2024;39(2):80–95. Published online October 30, 2023. doi:10.1177/02683555231211086.

In‑Office Care and Recovery

All procedures are:

Performed in our Park Ridge clinic
Performed under local anesthesia
No hospital admission or general anesthesia required
Typically associated with a prompt return to normal daily activities

Patients with physically demanding occupations may require temporary activity modification. Recovery recommendations depend on the procedure performed, extent of treatment, and individual clinical findings.

Schedule Your Varicose Vein Evaluation

If you are experiencing leg pain, swelling, heaviness, skin changes, or visible varicose veins, a proper evaluation can help determine which treatment approach would benefit you.

📞 Call (847) 518-9999 to schedule a vein evaluation with Dr. Tryzno.

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.

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