• Compression stockings have been shown to improve blood flow in leg veins. Patients with mildly symptomatic varicose veins will often be treated with compression stockings before other, invasive procedures. Most physicians consider compression therapy a necessary adjunct to any surgical therapies, to be initiated before and maintained after any surgery.

  • Injection therapy (sclerotherapy) is recommended for patients with small varicose veins. During this procedure, an irritant chemical such as salt solution or a sclerosing agent is injected into the offending veins, causing them to scar and seal off. Following the injections, compression bandages are applied to prevent blood from refilling the veins and to allow them to heal. Injection therapy carries risks such as residual brown spots at the injection sites, formation of blood clots in superficial veins, an allergic reaction to the injected irritant or the formation of new spider veins. It is not used to treat large varicose veins. Multiple treatments may be required.

  • Laser surgery may be used for treatment of certain varicose veins. This procedure was originally used on smaller varicose veins and spider veins, especially on the upper body and face, although it can now be used for varicose veins on the legs. The treatment works by directing bursts of light onto the vein, which causes it to slowly fade and disappear.

  • Ambulatory phlebectomy can be used to remove smaller varicose veins through a series of tiny skin punctures under local anesthesia. Scarring is kept to a minimum.

  • Vein stripping is a surgical treatment reserved for large varicose veins such as the greater saphenous vein of the leg. In this procedure, incompetent segments of large varicosed veins are tied off and surgically removed. For most patients, it is performed on an outpatient basis. 

  • Endoscopic vein surgery is typically reserved for advanced cases of vascular disease involving leg ulcers. Surgeons insert a small endoscope (a fiber optic device equipped with a tiny camera) into the veins to visualize vascular abnormalities from inside the vein and to continue providing these clear images as the abnormalities are surgically removed.

  • Vein ablation, also called saphenous vein ablation, is a catheter-based procedure that uses laser or radiofrequency energy to close off varicose veins. During this procedure, the physician inserts a long, thin tube (catheter) into the varicose vein and heats the tip of the catheter. As the catheter is removed, the heat destroys the vein. Radiofrequencies can also be used to close the vein.