Varicose veins can be reduced with conservative measures like compression stockings and exercise, but getting rid of them permanently requires a medical procedure. The good news: most modern treatments are minimally invasive, performed in an office setting, and allow you to walk out the same day. Which option is right depends on the size of your veins, the severity of your symptoms, and whether your insurance requires you to try conservative treatment first.
Why Varicose Veins Don’t Go Away on Their Own
Varicose veins form when the one-way valves inside your leg veins stop working properly. Blood that should flow upward toward the heart pools in the vein instead, stretching the walls outward. Once a valve is damaged and the vein is enlarged, it stays that way. No cream, supplement, or exercise routine will reverse structural damage to a vein wall.
That said, conservative measures can relieve symptoms and slow progression. They just won’t make the veins disappear.
What Compression Stockings Can and Can’t Do
Compression stockings squeeze your legs with graduated pressure, helping push blood back toward the heart. They reduce swelling, aching, and heaviness, but they don’t eliminate the veins themselves. In a randomized trial comparing compression stockings to surgery, patients in the compression group saw modest symptom improvement, but their quality of life scores didn’t change. Surgery produced significantly better outcomes.
Stockings come in different pressure levels, measured in millimeters of mercury (mmHg):
- 8 to 15 mmHg (low): Over-the-counter, for mild achiness and tired legs. Not strong enough for true varicose veins.
- 15 to 20 mmHg (medium): Also over-the-counter. Helpful for minor varicose veins, pregnancy-related swelling, or long flights.
- 20 to 30 mmHg (medical grade class I): The most commonly prescribed level for diagnosed varicose veins and chronic venous insufficiency.
- 30 to 40+ mmHg (medical grade class II and III): Reserved for severe cases like active venous ulcers or post-blood-clot complications.
Even if you’re planning a procedure, you’ll likely wear compression stockings during recovery. Many insurers also require a trial period of conservative therapy (typically six months of compression stockings, regular walking, leg elevation, and avoiding prolonged standing) before they’ll approve a procedure.
Minimally Invasive Procedures
Most varicose vein treatments today are done in an office or outpatient clinic with local numbing, not general anesthesia. The core idea behind all of them is the same: seal off or destroy the damaged vein so blood reroutes through healthy veins nearby. Your body has plenty of other pathways to carry blood back to your heart.
Thermal Ablation (Radiofrequency or Laser)
This is the most widely used treatment for larger varicose veins. A thin catheter is threaded into the damaged vein, and the tip heats up using either radiofrequency energy or laser energy. As the catheter is slowly pulled out, the heat collapses the vein walls and seals them shut. The vein is gradually absorbed by your body over the following weeks.
Thermal ablation ranks among the most effective options. In a large network meta-analysis comparing all major treatments, radiofrequency ablation ranked second and laser ablation ranked third for complete vein closure within six months.
Sclerotherapy
A solution or foam is injected directly into the varicose vein. The chemical irritates the vein lining, causing it to scar and close. Over a few weeks, the treated veins fade. Sclerotherapy works well for smaller varicose veins and spider veins. It does carry a higher rate of side effects compared to other options, including temporary brown spots at the injection site (which usually fade within three to six months), lumpiness or hardness along the treated vein, and minor redness where the needle entered.
Medical Adhesive (VenaSeal)
This newer approach uses a medical-grade glue (cyanoacrylate) delivered through a catheter to seal the vein shut. No heat is involved, which means less numbing is needed and there’s minimal risk of nerve irritation. In the same network meta-analysis, VenaSeal ranked first for complete vein closure at six months, first for reduced post-procedure pain, and lowest for adverse events. The odds of complications were 2.7 times higher with laser ablation and 3.3 times higher with sclerotherapy compared to VenaSeal.
Microphlebectomy
For bulging surface veins, a doctor can physically remove them through tiny punctures in the skin. Only the area being treated is numbed. The incisions are small enough that scarring is usually minimal. This is sometimes done alongside thermal ablation to address visible branches that remain after the main vein is sealed.
Traditional Surgery: Ligation and Stripping
Before minimally invasive options became standard, the main treatment was tying off the damaged vein where it connects to a deeper vein and then pulling it out through small incisions. This is still done as an outpatient procedure, but it’s less common now because catheter-based treatments achieve similar results with less discomfort and faster recovery. Surgery ranked fourth for complete closure in comparative analyses.
What Recovery Looks Like
Recovery from most minimally invasive procedures follows a similar pattern. You’ll typically leave the clinic about an hour after the procedure. You’ll wear a compression bandage and stockings continuously for the first 48 hours, then switch to stockings alone for another five days, wearing them day and night. If bruising and swelling haven’t settled by then, continuing the stockings for an additional week helps.
Walking normally right away is important. It keeps blood flowing and reduces the risk of clots. Most people avoid driving for about five days, mainly because leg soreness could interfere with braking safely in an emergency. Most patients return to normal activities within one to two weeks. Long-haul flights should wait at least four weeks.
Bruising along the treated vein is common and can look dramatic, but it fades. Some people feel a pulling or tightness in the leg for the first week or two as the sealed vein begins to be reabsorbed.
Insurance Coverage and Medical Necessity
Cosmetic treatment of varicose veins is rarely covered by insurance. To qualify for coverage, you’ll generally need to meet specific criteria. A common set of requirements includes documented symptoms that affect your daily activities (pain, swelling that limits mobility, skin changes, or ulceration near the ankle), an ultrasound within the past six months showing abnormal blood flow in the vein, and completion of a six-month trial of conservative therapy: walking, compression stockings, leg elevation, avoiding prolonged standing, and weight loss if applicable.
For sclerotherapy specifically, some insurers require that the veins bulge above the skin surface and measure at least 5 millimeters in diameter. If your veins are smaller or purely cosmetic, you’ll likely pay out of pocket. Costs vary widely by procedure and region, so asking your vein clinic for a detailed estimate before scheduling is worthwhile.
Which Treatment Is Best for You
The right procedure depends on the size, location, and severity of your varicose veins. Small surface veins and spider veins respond well to sclerotherapy. Larger veins with valve failure are better suited to thermal ablation or medical adhesive closure. Very large, bulging surface veins may need microphlebectomy. Many patients end up with a combination: thermal ablation for the main trunk vein, plus sclerotherapy or microphlebectomy for smaller branches.
A vascular ultrasound is the starting point. It maps which veins have faulty valves, how large they are, and whether deeper veins are involved. That information determines both your treatment options and whether insurance is likely to cover them. If your symptoms are mild and mostly cosmetic, compression stockings and regular exercise may be enough to keep you comfortable while you decide whether to pursue a procedure.