Varicose Vein Treatment Options: What Each One Does and How They Fit Together

What is the principle behind all vein treatment?

Varicose veins are the downstream result of a leaking valve higher up, usually in the great or small saphenous vein. Treating only the visible veins without closing the source gives a short-lived result, because the pressure simply finds the next tributary. Every modern plan therefore has two parts: close the source, then deal with the branches. The scan identifies the source; the surgeon chooses the tools.

What are the options?

The three endovenous methods are compared in detail on laser, radiofrequency or glue?

What do the guidelines recommend?

The European Society for Vascular Surgery 2022 guideline and NICE CG168 both recommend endovenous thermal ablation as the first-line treatment for a refluxing great or small saphenous vein, with foam sclerotherapy or surgery when thermal ablation is unsuitable. The ESVS guideline also recognises non-thermal methods such as cyanoacrylate glue as an alternative. Compression stockings are recommended for symptom relief and after procedures, but not as a substitute for treating reflux in people who are suitable for intervention. Treating tributaries at the same time as the trunk, rather than waiting to see whether they settle, is supported by trial evidence showing fewer later procedures.

How are treatments combined?

A typical plan for a leg with a refluxing great saphenous vein and several bulging tributaries is ablation of the trunk, by radiofrequency, laser or glue, with microphlebectomy of the larger tributaries at the same sitting and foam for any smaller ones. A leg with reflux only in a tributary, or with recurrent veins after previous treatment, may need foam alone. A leg with both saphenous trunks refluxing may be treated in one session or two. These decisions are made on the scan and discussed before anything is booked.

What is recovery like?

After keyhole treatment under local anaesthetic you walk out of the day-surgery unit, and walking is encouraged from the first day. Tightness and bruising along the treated vein are normal for one to two weeks. Most people return to desk work within a few days and to full exercise within two weeks, with heavy lifting and long flights deferred for a short period. Stockings are worn for a week or two after heat or foam treatment and often not at all after glue. A check scan at around six weeks confirms the vein has closed. Dr Choong's recovery guide covers the week-by-week detail.

Common questions about varicose vein treatment options

Can I just have the visible veins removed?

If the scan shows no reflux in the saphenous trunks, yes: microphlebectomy or foam alone is appropriate. If a trunk is refluxing, removing the surface veins without closing it tends to lead to new veins within a year or two, so the trunk is usually treated first or at the same time.

Do I need a general anaesthetic?

Not for the keyhole methods. Radiofrequency, laser, glue, foam and microphlebectomy are all done under local anaesthetic, with light sedation available if you prefer. Only traditional stripping surgery routinely needs a general or spinal anaesthetic.

Is one leg treated at a time?

Both legs can often be treated in one session under local anaesthetic if the plan for each is straightforward. Where two trunks and many tributaries are involved, splitting treatment into two sessions keeps each one comfortable and short.

Are the treated veins needed for anything later?

No. The superficial veins that are treated are already failing and are carrying blood the wrong way. The deep veins, which do the real work of returning blood to the heart, are left untouched, and the body reroutes flow through them.