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Varicose Veins: Should I Have a Surgical Procedure?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Varicose Veins: Should I Have a Surgical Procedure?

Get the facts

Your options

  • Have surgery or a procedure to close or remove your varicose veins.
  • Try home care to improve your symptoms. You can exercise, prop up your legs when resting, wear compression stockings, and lose weight if needed.

Key points to remember

  • You may want to first try some things at home to reduce pain or other symptoms from varicose veins. You can wear compression stockings, prop up your leg (or legs) on a pillow or a chair when you can, get some exercise, and lose weight if needed. If these steps don't help your symptoms, you may want to have surgery or a procedure.
  • Having surgery or a procedure is a better choice if you care a lot about how your legs look. Home treatment won't change the look of varicose veins. Surgery and other procedures also can reduce pain and other symptoms.
  • The size of your varicose veins affects the type of procedure or surgery you might have. If you have larger veins, your options may be surgery (ligation and stripping) or a less invasive procedure called endovenous ablation. If you have small to medium-sized varicose veins, your options may include sclerotherapy, external laser treatment, or a minor surgery called microphlebectomy.
  • Procedures that are used to close or remove larger varicose veins and keep them from coming back seem to work about the same. These procedures include endovenous ablation, sclerotherapy, and surgery.
  • Before you have any procedure, check your insurance to see if it covers the cost. Some policies do not cover procedures that are viewed as only being done for personal, not medical, reasons.
FAQs

What are varicose veins?

Varicose veins are twisted, enlarged veins near the surface of the skin. They are most common in the legs and ankles. You may have them in one or both legs.

They can make your legs ache, hurt, itch, and swell.

Even if you don't have symptoms, you may not like the way the veins make your legs look.

How are varicose veins treated?

You can treat varicose veins with home care, surgery, or another procedure.

Home treatment

For many people, home treatment relieves pain and other symptoms. If you don't have serious problems from varicose veins, home care may be all that you need. But home treatment won't make your varicose veins go away or look better.

You can:

  • Wear compression stockings.
  • Prop up your legs on a pillow or a chair when you can.
  • Exercise to improve blood flow in your legs.
  • Lose weight if needed. (Being overweight can make varicose veins worse.)

If you still have pain or other symptoms after trying home treatment, you may want to have surgery or another procedure. If your main concern is how your legs look, you might consider a procedure. Home care won't change how your legs look.

Procedures for varicose veins

These less invasive procedures close or remove the varicose veins. They can usually be done in your doctor's office or clinic.

  • External laser treatment. A laser is a highly focused beam of light. Heat from the laser damages the vein and causes scar tissue, which closes the vein. This laser treatment is used on the outside of the skin to close off small veins near the surface.
  • Endovenous ablation. Endovenous means that the procedure is done inside the vein. Ablation means a doctor uses something to damage and close off the vein. A doctor inserts a tube into a vein through a small cut in the skin. The doctor may use heat, chemicals, or a small wire to slightly damage the vein. Scar tissue forms and closes the vein. Or a special glue may be used to close the vein.
  • Sclerotherapy. A chemical is injected into the varicose vein to damage and scar the inside of the vein. This closes the vein.

Phlebectomy (also called microphlebectomy or stab avulsion) is usually done along with another procedure or surgery to treat varicose veins. Several tiny cuts are made in the skin. The veins are removed through these cuts. Stitches usually aren't needed.

Surgery for varicose veins

Vein ligation and stripping is a surgical treatment for varicose veins. One or more cuts are made over the vein, and the vein is tied off (ligated) in two places. All or part of the vein between the tied off areas is usually removed (stripped). You may be asleep during the surgery, but it also can be done while you are awake. If you are awake, you will get medicine to numb your leg and prevent pain. You'll probably have a few stitches.

How well do procedures work for varicose veins?

Most treatments for larger veins seem to work about the same to close varicose veins. Endovenous ablation treatments appear to work a little better than surgery. And endovenous ablation and surgery appear to work better than sclerotherapy.footnote 1

Endovenous ablation using laser or radiofrequency heat works in more than 96 out of 100 people. These treatments may not work for fewer than 4 out of 100 people.footnote 1

Surgery works in about 90 out of 100 people. It may not work for about 10 out of 100 people.footnote 1

Sclerotherapy works in more than 70 out of 100 people. It may not work for up to 30 out of 100 people.footnote 1

All of these treatments appear to work about the same to:

  • Relieve symptoms.
  • Improve the look of the skin.
  • Improve quality of life.

What are the risks of procedures for varicose veins?

Studies show that all of the treatments have a similar risk that the varicose veins may come back.footnote 1

Endovenous ablation and sclerotherapy have some risks. But problems that need treatment are not common.

Here are examples of risks:

  • Blood clots may form in the veins.
  • You may have small scars.
  • You could have bleeding sores.
  • You could have an allergic reaction to the liquid that is put into the vein during sclerotherapy. This is rare.
  • The color of your skin could change and stay that way, or tiny new blood vessels could form in the area that was treated. These problems are rare.

Vein ligation and stripping also has some risks. But problems that need treatment are not common.

Examples of risks:

  • You could bleed a lot.
  • You could get an infection.
  • You might have numbness in your legs.
  • You could have small scars where the vein was removed.
  • You could have problems from anesthesia.

Why might your doctor recommend a procedure for varicose veins?

Your doctor might suggest surgery or a procedure if:

  • You have tried compression stockings and other home care and you still have pain and swelling.
  • You want to treat varicose veins so that your legs will look better.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have a procedure for varicose veins Have a procedure for varicose veins
  • You may be asleep or awake, depending on the procedure.
  • You can go home the same day.
  • You may wear compression bandages or stockings after treatment.
  • Your symptoms are likely to get better or go away.
  • You may be happier with the way your legs look.
  • Your varicose veins may come back.
  • Your pain or other symptoms may come back.
  • You may have side effects or problems from the procedure.
Use home treatment Use home treatment
  • You wear compression stockings.
  • You prop up your legs on a chair or a pillow to keep blood from pooling.
  • You get regular exercise to improve the blood flow in your legs.
  • You can lose weight, if needed, to improve symptoms.
  • Your symptoms may get better or go away.
  • You don't have pain or other side effects from surgery.
  • Your symptoms might not get better.
  • Home care won't change how your varicose veins look.
  • Compression stockings can be hard to put on and take off. Wearing them can be uncomfortable until you get used to them.

Personal stories about varicose veins

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I wear shorts and skirts a lot. Several years ago, I stopped trying to keep a tan all the time because of the risk of skin cancer. So now that I don't have that brown skin, you can really see my veins. I also started to wonder if the veins were related to the aching I have sometimes in my legs. I talked to my doctor about it and found out that the aching probably is not related to the spider veins. But I decided to have them treated anyway, because I really don't like the way my legs look.

Margaret, age 46

My main reason for treating my varicose veins is to relieve the aching and fatigue. My legs are so tired at the end of the day! My doctor said that I could try surgery, but I don't feel like my legs bother me enough to take the risk, even though she says it's a pretty safe surgery. So we talked about some other options, like compression stockings, and about putting my feet up several times a day. And about walking more. Who would have thought that being on my feet more might make my legs less tired?

Carolyn, age 67

I have several of those long, ropy-looking, twisted varicose veins. And my legs are pretty skinny, so they really stand out. I'm not concerned with how my legs look, but I'm a police officer and I'm on my feet all day. At the end of the day, my legs really ache. We talked about trying treatments at home and at work. If those don't work, I'll try one of the procedures.

Diego, age 38

I would like to do something about all my varicose veins because I don't like the way they look. But I don't want to pay for treatments. So I decided to wear more pants and wear darker hose with my skirts.

Suzanne, age 56

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a procedure for varicose veins

Reasons to try home care for varicose veins

I'm really bothered by the way my legs look because of my varicose veins.

I'm not bothered by how my legs look.

More important
Equally important
More important

I still have symptoms from my varicose veins, even with home care.

Home care is helping my symptoms.

More important
Equally important
More important

I'm not worried about possible side effects from a procedure for varicose veins.

I don't want to have the risk of any side effects from a procedure.

More important
Equally important
More important

Having a procedure is worth it to me, even if there's a chance that my varicose veins will come back.

I don't want to have a procedure if my varicose veins could come back.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a procedure

NOT having a procedure

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, I might be able to treat my varicose veins without having surgery or a procedure.
2, Home treatment can change how my legs look from varicose veins.
3, The kind of procedure I'll have may depend on the size of my varicose veins.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer David A. Szalay MD - Vascular Surgery
Primary Medical Reviewer Kara L. Cadwallader MD - Family Medicine

References
Citations
  1. Whing J, et al. (2021). Interventions for great saphenous vein incompetence. Cochrane Database of Systematic Reviews, (8). DOI:10.1002/14651858.CD005624.pub4. Accessed August 30, 2022.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Varicose Veins: Should I Have a Surgical Procedure?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have surgery or a procedure to close or remove your varicose veins.
  • Try home care to improve your symptoms. You can exercise, prop up your legs when resting, wear compression stockings, and lose weight if needed.

Key points to remember

  • You may want to first try some things at home to reduce pain or other symptoms from varicose veins. You can wear compression stockings, prop up your leg (or legs) on a pillow or a chair when you can, get some exercise, and lose weight if needed. If these steps don't help your symptoms, you may want to have surgery or a procedure.
  • Having surgery or a procedure is a better choice if you care a lot about how your legs look. Home treatment won't change the look of varicose veins. Surgery and other procedures also can reduce pain and other symptoms.
  • The size of your varicose veins affects the type of procedure or surgery you might have. If you have larger veins, your options may be surgery (ligation and stripping) or a less invasive procedure called endovenous ablation. If you have small to medium-sized varicose veins, your options may include sclerotherapy, external laser treatment, or a minor surgery called microphlebectomy.
  • Procedures that are used to close or remove larger varicose veins and keep them from coming back seem to work about the same. These procedures include endovenous ablation, sclerotherapy, and surgery.
  • Before you have any procedure, check your insurance to see if it covers the cost. Some policies do not cover procedures that are viewed as only being done for personal, not medical, reasons.
FAQs

What are varicose veins?

Varicose veins are twisted, enlarged veins near the surface of the skin. They are most common in the legs and ankles. You may have them in one or both legs.

They can make your legs ache, hurt, itch, and swell.

Even if you don't have symptoms, you may not like the way the veins make your legs look.

How are varicose veins treated?

You can treat varicose veins with home care, surgery, or another procedure.

Home treatment

For many people, home treatment relieves pain and other symptoms. If you don't have serious problems from varicose veins, home care may be all that you need. But home treatment won't make your varicose veins go away or look better.

You can:

  • Wear compression stockings.
  • Prop up your legs on a pillow or a chair when you can.
  • Exercise to improve blood flow in your legs.
  • Lose weight if needed. (Being overweight can make varicose veins worse.)

If you still have pain or other symptoms after trying home treatment, you may want to have surgery or another procedure. If your main concern is how your legs look, you might consider a procedure. Home care won't change how your legs look.

Procedures for varicose veins

These less invasive procedures close or remove the varicose veins. They can usually be done in your doctor's office or clinic.

  • External laser treatment. A laser is a highly focused beam of light. Heat from the laser damages the vein and causes scar tissue, which closes the vein. This laser treatment is used on the outside of the skin to close off small veins near the surface.
  • Endovenous ablation. Endovenous means that the procedure is done inside the vein. Ablation means a doctor uses something to damage and close off the vein. A doctor inserts a tube into a vein through a small cut in the skin. The doctor may use heat, chemicals, or a small wire to slightly damage the vein. Scar tissue forms and closes the vein. Or a special glue may be used to close the vein.
  • Sclerotherapy. A chemical is injected into the varicose vein to damage and scar the inside of the vein. This closes the vein.

Phlebectomy (also called microphlebectomy or stab avulsion) is usually done along with another procedure or surgery to treat varicose veins. Several tiny cuts are made in the skin. The veins are removed through these cuts. Stitches usually aren't needed.

Surgery for varicose veins

Vein ligation and stripping is a surgical treatment for varicose veins. One or more cuts are made over the vein, and the vein is tied off (ligated) in two places. All or part of the vein between the tied off areas is usually removed (stripped). You may be asleep during the surgery, but it also can be done while you are awake. If you are awake, you will get medicine to numb your leg and prevent pain. You'll probably have a few stitches.

How well do procedures work for varicose veins?

Most treatments for larger veins seem to work about the same to close varicose veins. Endovenous ablation treatments appear to work a little better than surgery. And endovenous ablation and surgery appear to work better than sclerotherapy.1

Endovenous ablation using laser or radiofrequency heat works in more than 96 out of 100 people. These treatments may not work for fewer than 4 out of 100 people.1

Surgery works in about 90 out of 100 people. It may not work for about 10 out of 100 people.1

Sclerotherapy works in more than 70 out of 100 people. It may not work for up to 30 out of 100 people.1

All of these treatments appear to work about the same to:

  • Relieve symptoms.
  • Improve the look of the skin.
  • Improve quality of life.

What are the risks of procedures for varicose veins?

Studies show that all of the treatments have a similar risk that the varicose veins may come back.1

Endovenous ablation and sclerotherapy have some risks. But problems that need treatment are not common.

Here are examples of risks:

  • Blood clots may form in the veins.
  • You may have small scars.
  • You could have bleeding sores.
  • You could have an allergic reaction to the liquid that is put into the vein during sclerotherapy. This is rare.
  • The color of your skin could change and stay that way, or tiny new blood vessels could form in the area that was treated. These problems are rare.

Vein ligation and stripping also has some risks. But problems that need treatment are not common.

Examples of risks:

  • You could bleed a lot.
  • You could get an infection.
  • You might have numbness in your legs.
  • You could have small scars where the vein was removed.
  • You could have problems from anesthesia.

Why might your doctor recommend a procedure for varicose veins?

Your doctor might suggest surgery or a procedure if:

  • You have tried compression stockings and other home care and you still have pain and swelling.
  • You want to treat varicose veins so that your legs will look better.

2. Compare your options

  Have a procedure for varicose veins Use home treatment
What is usually involved?
  • You may be asleep or awake, depending on the procedure.
  • You can go home the same day.
  • You may wear compression bandages or stockings after treatment.
  • You wear compression stockings.
  • You prop up your legs on a chair or a pillow to keep blood from pooling.
  • You get regular exercise to improve the blood flow in your legs.
  • You can lose weight, if needed, to improve symptoms.
What are the benefits?
  • Your symptoms are likely to get better or go away.
  • You may be happier with the way your legs look.
  • Your symptoms may get better or go away.
  • You don't have pain or other side effects from surgery.
What are the risks and side effects?
  • Your varicose veins may come back.
  • Your pain or other symptoms may come back.
  • You may have side effects or problems from the procedure.
  • Your symptoms might not get better.
  • Home care won't change how your varicose veins look.
  • Compression stockings can be hard to put on and take off. Wearing them can be uncomfortable until you get used to them.

Personal stories

Personal stories about varicose veins

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I wear shorts and skirts a lot. Several years ago, I stopped trying to keep a tan all the time because of the risk of skin cancer. So now that I don't have that brown skin, you can really see my veins. I also started to wonder if the veins were related to the aching I have sometimes in my legs. I talked to my doctor about it and found out that the aching probably is not related to the spider veins. But I decided to have them treated anyway, because I really don't like the way my legs look."

— Margaret, age 46

"My main reason for treating my varicose veins is to relieve the aching and fatigue. My legs are so tired at the end of the day! My doctor said that I could try surgery, but I don't feel like my legs bother me enough to take the risk, even though she says it's a pretty safe surgery. So we talked about some other options, like compression stockings, and about putting my feet up several times a day. And about walking more. Who would have thought that being on my feet more might make my legs less tired?"

— Carolyn, age 67

"I have several of those long, ropy-looking, twisted varicose veins. And my legs are pretty skinny, so they really stand out. I'm not concerned with how my legs look, but I'm a police officer and I'm on my feet all day. At the end of the day, my legs really ache. We talked about trying treatments at home and at work. If those don't work, I'll try one of the procedures."

— Diego, age 38

"I would like to do something about all my varicose veins because I don't like the way they look. But I don't want to pay for treatments. So I decided to wear more pants and wear darker hose with my skirts."

— Suzanne, age 56

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a procedure for varicose veins

Reasons to try home care for varicose veins

I'm really bothered by the way my legs look because of my varicose veins.

I'm not bothered by how my legs look.

       
More important
Equally important
More important

I still have symptoms from my varicose veins, even with home care.

Home care is helping my symptoms.

       
More important
Equally important
More important

I'm not worried about possible side effects from a procedure for varicose veins.

I don't want to have the risk of any side effects from a procedure.

       
More important
Equally important
More important

Having a procedure is worth it to me, even if there's a chance that my varicose veins will come back.

I don't want to have a procedure if my varicose veins could come back.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a procedure

NOT having a procedure

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. I might be able to treat my varicose veins without having surgery or a procedure.

  • True
  • False
  • I'm not sure
That's right. For many people, home treatment works well to relieve pain and other symptoms. If you don't have serious problems from varicose veins, home care may be all that you need.

2. Home treatment can change how my legs look from varicose veins.

  • True
  • False
  • I'm not sure
You're right. Having surgery or a procedure is a better choice if you care a lot about how your legs look. Home treatment won't change the look of varicose veins.

3. The kind of procedure I'll have may depend on the size of my varicose veins.

  • True
  • False
  • I'm not sure
You're right. The size of your varicose veins affects the type of procedure. If you have large veins, your options may include surgery or endovenous ablation. If you have smaller veins, your options may include sclerotherapy or external laser therapy.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer David A. Szalay MD - Vascular Surgery
Primary Medical Reviewer Kara L. Cadwallader MD - Family Medicine

References
Citations
  1. Whing J, et al. (2021). Interventions for great saphenous vein incompetence. Cochrane Database of Systematic Reviews, (8). DOI:10.1002/14651858.CD005624.pub4. Accessed August 30, 2022.

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