Varicose veins are enlarged, twisted veins, often appearing blue or dark purple, most frequently in the legs and feet. This occurs when one-way valves inside the veins weaken, allowing blood to pool and causing veins to stretch and bulge. Treatment options range from traditional surgery to less invasive modern techniques.
Traditional Surgical Procedures
Traditional surgical procedures are more invasive, addressing severely damaged veins. They physically remove or tie off affected veins. While still used, less invasive alternatives are now more common.
High-tie ligation and vein stripping
High-tie ligation and vein stripping treats larger, severe varicose veins. Small incisions are made, in the groin and lower leg. The surgeon ties off the vein (ligation) to stop blood flow and inserts a wire to remove a segment (stripping) through the lower incision.
Ambulatory phlebectomy
Ambulatory phlebectomy, or stab avulsion, removes smaller, superficial varicose veins. It involves tiny incisions along the bulging vein. Through these punctures, specialized hooks remove vein segments. This outpatient procedure is performed under local anesthesia and does not require stitches.
Minimally Invasive Treatments
Minimally invasive treatments are often preferred for varicose veins due to reduced invasiveness and quicker recovery. These procedures close off diseased veins, redirecting blood through healthy ones.
Endovenous Laser Ablation (EVLA)
Endovenous Laser Ablation (EVLA) uses laser energy to seal the affected vein. A thin laser fiber is inserted into the diseased vein, guided by ultrasound. Local anesthetic is administered. As the fiber is withdrawn, it delivers heat, causing vein walls to collapse and seal. The body reabsorbs the treated vein.
Radiofrequency Ablation (RFA)
Radiofrequency Ablation (RFA) is another heat-based method using radiofrequency energy to close varicose veins. Similar to EVLA, a catheter is inserted under ultrasound guidance. Radiofrequency energy heats vein walls, causing them to shrink and seal. This outpatient procedure takes about an hour.
Sclerotherapy
Sclerotherapy involves injecting a sclerosant solution directly into the varicose vein to irritate its lining and close it. Liquid sclerotherapy is used for smaller veins. Foam sclerotherapy, created by mixing sclerosant with air, has a thicker consistency. This displaces blood and contacts vein walls more directly, making it effective for larger or deeper varicose veins.
Adhesive closure
Adhesive closure is a newer non-thermal approach. It involves injecting a medical-grade adhesive (cyanoacrylate) into the diseased vein via a small catheter, guided by ultrasound. The adhesive seals the vein, and the body gradually absorbs it. An advantage is that it requires only a single needle prick for local anesthetic and no compression stockings post-procedure.
When Varicose Vein Treatment is Necessary
While some seek treatment for cosmetic reasons, varicose vein procedures often alleviate uncomfortable symptoms and prevent complications. A healthcare professional determines treatment after evaluating a patient’s condition and symptoms.
Common symptoms indicating a need for treatment include persistent aching, heaviness, throbbing, or muscle cramping in the legs, especially after prolonged standing or sitting. Swelling in the lower legs and ankles, plus itching around affected veins, also prompt medical evaluation. These symptoms can worsen if left unaddressed.
More severe issues include skin changes like discoloration or hardening around the ankles, or slow-healing venous leg ulcers (open sores). Other complications may involve bleeding from fragile varicose veins or superficial thrombophlebitis (inflammation and clotting of a vein under the skin). A healthcare provider assesses these to determine the most appropriate action.
After Varicose Vein Procedures
After varicose vein procedures, recovery varies based on the specific treatment and individual healing. Post-procedure care supports healing and minimizes discomfort.
Immediately after a procedure, patients wear compression stockings to reduce swelling and promote blood flow. Light walking is encouraged to aid circulation and prevent blood clots; prolonged standing or sitting should be avoided. Rest is important, but complete immobility is not recommended.
Recovery time ranges from a few days for less invasive procedures to a few weeks for traditional surgical methods. Patients may experience temporary side effects like bruising, swelling, tenderness, or mild pain, manageable with over-the-counter pain relievers. Bruising fades within two to three weeks. Adhering to post-procedure instructions, including wound care and activity restrictions, and attending follow-up appointments, ensures a smooth recovery and favorable outcome.