Varithena is a form of sclerotherapy. Specifically, it’s an FDA-approved injectable microfoam that treats varicose veins by collapsing them from the inside. The active ingredient is a sclerosing agent that damages the inner lining of the vein wall, causing the vein to seal shut and eventually be absorbed by the body. What sets Varithena apart from traditional liquid sclerotherapy is its foam consistency, which allows it to treat larger, deeper veins that liquid agents can’t reach as effectively.
What Varithena Treats
Varithena is approved to treat incompetent great saphenous veins, accessory saphenous veins, and the visible varicose veins branching off those systems, both above and below the knee. The great saphenous vein is the long vein running from the ankle up the inner leg to the groin, and it’s the most common source of varicose vein problems. In clinical trials, treated veins ranged from about 1.5 mm to nearly 26 mm in diameter, so the foam works across a wide spectrum of vein sizes.
“Incompetent” in this context means the tiny one-way valves inside the vein have failed. Blood pools and flows backward, creating the bulging, rope-like veins visible under the skin, along with symptoms like aching, heaviness, swelling, and skin changes.
How the Procedure Works
The foam is injected directly into the problem vein through a needle or catheter, guided by real-time ultrasound imaging. The doctor uses ultrasound to map out the target vein and locate connecting veins beforehand, then monitors the foam as it spreads through the vein during injection. Once the foam contacts the vein wall, it causes the vessel to spasm and contract. The doctor checks for this narrowing along the full length of the treated segment to confirm adequate contact.
One notable advantage over heat-based vein treatments (radiofrequency or laser ablation) is that Varithena doesn’t require tumescent anesthesia, the series of numbing injections along the entire length of the vein that thermal procedures demand. This means shorter procedure times and significantly less discomfort during treatment. Most patients receive only a local numbing agent at the injection site itself.
How It Compares to Thermal Ablation
A network meta-analysis comparing Varithena to thermal ablation (laser and radiofrequency) found no statistically significant difference in vein closure rates between the two approaches. That finding held up even when researchers looked at longer-term data, with a median follow-up of four years. There was also no evidence that Varithena carried a higher risk of deep vein clots compared to thermal ablation, surgery, or other foam treatments.
The practical differences come down to the experience during and after treatment. Thermal ablation requires multiple anesthetic injections and uses a catheter threaded through the vein to deliver heat. Varithena involves fewer needle sticks and no heat, which many patients find less intimidating. However, comparative data on post-procedure pain and quality-of-life scores remain limited, so the recovery experience is harder to compare head-to-head.
Common Side Effects
Side effects are mostly localized to the treated leg. In clinical trials, the most frequently reported issues were:
- Leg pain: 14.9% of treated patients, compared to 9.3% with placebo
- Trapped blood at the injection site: 10.5%, where small clots form in the collapsed vein segment (these are expected and not the same as a dangerous deep vein clot)
- Limb discomfort: 7.3%
- Bruising: 5.3% at the injection site, 3.4% more broadly
Ultrasound screening after treatment detected small vein clots in about 7.2% of patients across clinical studies. The most common type, found in 2.9% of patients, was a small, non-blocking clot near the groin that caused no symptoms. These are monitored with follow-up ultrasound and typically resolve on their own.
Who Should Not Get Varithena
Varithena is not an option if you have an active blood clot (deep vein thrombosis or pulmonary embolism), because the treatment itself carries a small clotting risk and can increase the activity of certain clotting factors in the blood. It’s also contraindicated if you’ve ever had a severe allergic reaction to the active ingredient, as anaphylaxis is possible and more likely with larger injection volumes.
Insurance and Eligibility Requirements
Most insurers cover Varithena when it’s deemed medically necessary, but you’ll typically need to meet specific criteria first. Using Aetna’s policy as a representative example: you must complete a three-month trial of wearing medical-grade compression stockings (20 mmHg or higher) before the procedure will be approved. Your symptoms, such as recurrent superficial blood clots, persistent pain, or swelling that interferes with daily activities, need to have continued despite that conservative treatment. An ultrasound must also confirm the problem vein is at least 2.5 mm in diameter.
If your varicose veins are purely cosmetic with no symptoms, insurance generally won’t cover the procedure.
What Recovery Looks Like
You can return to your normal diet and most daily activities right away, but the first month involves a structured routine to support healing. For the first 48 hours, you leave the bandages and compression stockings in place without removing them. After that, you switch to compression socks worn around the clock, day and night, for a full 14 days.
During the first week, avoid heavy exercise like weightlifting or squatting. For the first 28 days, walk for a total of one hour each day, broken into 10- to 20-minute stretches. Long periods of sitting are discouraged during this window, including extended car or plane trips. The general theme is to keep moving without overdoing it: gentle walking promotes blood flow through the deep veins while the treated superficial veins close down permanently.
Standing still for long stretches is also best avoided throughout recovery, as it puts pressure on the healing veins and can worsen swelling in the treated leg.