Varicose vein treatments have seen a huge improvement in quality and effectiveness in the last 15 or so years. Many options are minimally invasive, cause little to no pain, and have almost no down-time. Treatments can include chemical injections, specially applied heat, or surgical techniques to collapse or completely remove your varicose veins.
Sclerotherapy is a common in-office treatment for spider veins that requires no anesthesia and has almost no down-time. Your vein specialist injects a chemical called a sclerosant into your varicose veins using a fine needle. The sclerosant solution irritates the lining of the vein, causing it to collapse and eventually dissolve.
Foam sclerotherapy uses a foam sclerosant, rather than a traditional liquid one. It can be more effective in treating larger varicose veins because the foam displaces the blood in the vein and coats the vein walls more completely. Foam sclerotherapy is often done with ultrasound guidance so your doctor can see and treat deeper veins that aren’t visible on the surface of your skin.
Recovery after sclerotherapy and foam sclerotherapy is mild. Most people can go back to work the same day. You’ll have to wear compression stockings for about one week after treatment to compress your treated veins and help you heal. Your doctor may recommend that you avoid strenuous activity for one week.
Side effects are rare, but may include bruising, inflammation, skin discoloration, or trapped blood. Your doctor can address these issues on your follow-up appointment.
Endovenous thermal ablation (EVTA)
There are two types of thermal ablation techniques: radio frequency ablation (RFA)
and endvenous laser ablation (EVLA)
- RFA is a minimally-invasive treatment for larger varicose veins that is very effective and has little down-time. It’s an in-office procedure done under local anesthesia. Your doctor makes a tiny incision in your vein and inserts a narrow, wire-like catheter into your vein to heat it from the inside with bursts of radiofrequency energy. The heat shrinks your varicose vein, causing it to collapse and eventually disappear.
- EVLA works the same way as RFA, but uses laser energy to heat the vein, rather than radiofrequency energy. EVLA is considered just as effective as RFA.
Recovery after EVTA is usually mild. You may have to take one day off of work. Some people can go back to work the same day though. You’ll have to wear compression stockings for about two weeks to compress your treated veins and help you heal. You will also have to avoid strenuous exercise for at least one week.
Side effects of EVTA are rare. You may have some feeling of tightness, tenderness, and mild pain for a few days after treatment.
- Phlebectomy (also known as ambulatory phlebectomy or micro-phlebectomy) is performed in-office with local anesthetic to remove superficial varicose veins. A series of small incisions or punctures are made along the length of the vein and is removed piece by piece. Phlebectomy may be combined with other procedures for a more comprehensive treatment.
- Transilluminated powered phlebectomy (TIPP) is a newer alternative to traditional phlebectomy that requires less incisions and can be performed more quickly. It can be done under general or local anesthesia. Your doctor makes one or two small incision near your varicose veins and inserts a narrow lighted wand to make them visible through your skin. A second wand is inserted to cut and suction away your varicose veins.
Recovery after phlebectomy and TIPP is mild and usually trouble-free. The incisions or punctures from the procedures only require small bandages. You’ll have to avoid strenuous activity and wear compression stockings for about one to two weeks after treatment.
Side effects can include mild pain and bruising. You may have some light scarring from the incisions or punctures, but these usually fade in six months or so.
- Ligation and stripping are two procedures that can be performed to tie-off your varicose vein (ligation) and then pull it out through incisions in your ankles and groin (stripping). You’ll be put under general anesthesia. Ligation and stripping is usually done on the great saphenous vein, which is the largest vein in your body that runs from your ankles to your groin. Ligation and stripping of varicose veins is now uncommon because EVTA is usually more effective and less invasive.
Recovery after ligation and stripping is quite painful and can take up to four weeks. You will have to wear compression stockings for a few weeks after treatment depending on your doctor’s instructions. You will also have to avoid strenuous activity while you heal.
Side effects can include discomfort, pain, bruising, hematoma, and numbness.
- Endoscopic vein surgery is used in advanced cases of varicose veins involving skin ulcers, or if other treatments have failed. It can be done under local or general anesthesia. Your surgeon makes small incisions near your veins and guides in a thin tube called an endoscope that has a camera and surgical tool on its end. Your surgeon monitors the video feed from the endoscope while tying off and closing your varicose veins.
Recovery after endoscopic vein surgery can take a few weeks, but is usually mild since the procedure is minimally-invasive. The incisions will be stitched closed and bandaged. Your doctor may also have you wear compression stockings to prevent blood clots and help you heal.
Side effects can include bruising, aching, and inflammation, but these conditions usually subside after a few days.
Varicose vein treatment costs vary depending on the procedures you have done, as well as your area, physician, and health insurance coverage. When you have your varicose veins evaluated you can talk to your doctor about procedure costs, and you can also contact your health insurance provider for exact cost information.