Varicose veins are a common condition where superficial veins, usually in the legs, become enlarged, twisted, and visible beneath the skin. This happens when one-way valves inside the veins weaken, causing blood to pool instead of flowing efficiently back toward the heart. While the public often uses the term “varicose vein surgery” broadly, the treatment encompasses several distinct, specialized procedures performed by vascular specialists. Clarifying these options helps patients understand modern treatments for venous insufficiency.
Naming the Types of Varicose Vein Treatment
Varicose vein treatment falls under phlebology or vascular surgery and is categorized into methods that seal the vein shut or physically remove it. Sealing methods include Endovenous Ablation (using thermal energy) and Sclerotherapy (using a chemical solution). Physical removal techniques are Ambulatory Phlebectomy or the more traditional Vein Ligation and Stripping. Modern practice favors less invasive procedures designed to eliminate the faulty vein, allowing blood flow to reroute naturally through surrounding healthy veins.
Understanding Minimally Invasive Procedures
Minimally invasive treatments are the preferred approach for addressing the underlying cause of varicose veins. Endovenous Ablation involves inserting a thin catheter directly into the affected vein under ultrasound guidance. This procedure uses intense heat, delivered by a laser (EVLA) or radiofrequency waves (RFA), to damage the vein wall. The thermal energy causes the vein to collapse and seal shut instantaneously, and the body naturally absorbs the closed-off vessel over time.
Sclerotherapy is a widely used, non-surgical method that does not rely on heat. A liquid or foamed solution, called a sclerosant, is injected directly into the problematic vein. The sclerosant irritates the vein lining, causing it to swell and scar shut (sclerosis). Foam sclerotherapy is effective for larger veins because the foam displaces blood, maximizing contact with the vein wall. These sealing procedures are typically performed in an outpatient setting using local anesthesia.
Traditional Surgical Removal Techniques
Traditional methods involve the physical removal or disconnection of the vein, requiring more extensive intervention than ablation. Vein Ligation and Stripping is the classic surgical approach, now reserved for severe cases where the vein is exceptionally large or twisted. This procedure requires an incision, often in the groin or calf, where the surgeon ties off the vein (ligation). A flexible wire is then used to physically pull out the long segment of the vein (stripping) through a lower incision. This invasive technique is usually performed under general or spinal anesthesia.
Ambulatory Phlebectomy, or micro-phlebectomy, is a minor surgical procedure that removes superficial, bulging varicose veins through tiny, slit-like incisions. These small incisions often do not require stitches and heal quickly with minimal scarring. Using specialized instruments, the surgeon physically extracts the vein segments piece by piece. This technique is often performed alongside endovenous ablation to remove visible branches remaining after the main source vein has been sealed.
What to Expect After Treatment
Immediate Post-Procedure Care
Post-treatment recovery involves a few general expectations regardless of the technique used. Patients are encouraged to begin walking immediately after the procedure to promote circulation and reduce the risk of clot formation. The most important component of post-procedure care is the use of compression stockings, worn as prescribed, often continuously for the first few days and then only during the daytime for one to two weeks. Compression minimizes swelling, bruising, and discomfort by supporting the treated veins and forcing them to remain closed.
Recovery and Follow-Up
Mild pain, bruising, and a tight sensation are normal side effects, usually managed with over-the-counter anti-inflammatory medication. Patients with desk jobs often return to work within two to five days, though jobs involving heavy lifting or prolonged standing may require one to two weeks of recovery. Follow-up appointments ensure the treated vein has successfully closed and monitor for complications.