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?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

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 support or 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.
Surgery can leave tiny scars on your legs.
The size of your varicose veins affects the type of treatment you might have. If you have larger veins, you are likely to have surgery (ligation and stripping) or less invasive procedures such as radiofrequency closure or endovenous laser treatment. Small to medium-sized varicose veins usually are treated with sclerotherapy, external laser treatment, or a minor surgery called microphlebectomy.
Procedures that are used to close varicose veins and keep them from coming back seem to work about the same. These procedures include laser treatment, radiofrequency closure, sclerotherapy, and surgery.
If you have private insurance, check to see if it covers the cost before you have any procedure. Like provincial health plans, some private insurance 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 for 6 to 12 months, you may want to have surgery or a procedure. If your main concern is how your legs look, you could have treatment whenever you want. 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.

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. Lasers may be used:
- On the outside of the skin (external laser) to close off small veins near the surface.
- Inside a vein (endovenous laser) to close large veins. The doctor places a thin tube called a catheter into the vein through a small cut in the skin.
Radiofrequency closure. This procedure uses a type of energy that is different from that of a laser to close off large varicose veins in the legs. A small cut is made in the vein. The energy is directed through a thin tube placed in the cut.
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'll need general or spinal anesthesia for this surgery. You'll probably have a few stitches.

How well do procedures work for varicose veins?

Laser treatment, radiofrequency closure, and sclerotherapy seem to work as well as surgery.^{footnote 1}

All of the treatments work about the same in how well they close off varicose veins. The treatments work in about 80 to 93 out of 100 people. The treatments may not work for about 7 to 20 out of 100 people.^{footnote 2}

These treatments may also:

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 3}

Endovenous laser treatment, radiofrequency closure, and sclerotherapy have some risks:

Blood clots may form in the veins.
You may have small scars.
Your skin may be numb where the thin tube is put in for radiofrequency closure or endovenous laser treatment.
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 colour 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:

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.

People who have had blood clots in a deep vein (deep vein thrombosis) or blood clots and inflammation in a small vein near the surface of the skin (thrombophlebitis) may be at greater risk for problems from surgery for varicose veins.

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 have to wear compression stockings for a week or more 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.
Side effects may include:
- Burning.
- Infection.
- Itching.
- Small scars.
- A lasting change in skin colour in the area that was treated.

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 do more 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 hot and uncomfortable.

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.

Wintering in Arizona, 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 these special panty hose that compress the leg veins, 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 blue 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 treatments like elastic stockings, but in my job that isn't practical. My doctor said that I'm a good candidate for surgery to remove the long veins and that the results should be pretty good.

Diego, age 38

I would like to do something about all my varicose veins, but until my youngest daughter gets out of college, we really can't afford it. I also know that treatment sometimes can cause some discoloration or scarring, which I would also like to avoid. So I wear my support hose, elevate my legs, 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:

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

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

What matters to you

Print Summary

Credits and References

Credits

Author	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	David A. Szalay MD - Vascular Surgery

References

Citations

Gloviczki P, et al. (2011). The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery, 53(16S): 2S–48S. DOI:10.1016/j.jvs.2011.01.079. Accessed December 29, 2014.
Van den Bos R, et al. (2009). Endovenous therapies of lower extremity varicosities: A meta-analysis. Journal of Vascular Surgery, 49(1): 230–239.
Nesbitt C, et al. (2014). Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database of Systematic Reviews (7). DOI: 10.1002/14651858.CD005624.pub3. Accessed December 16, 2014.

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.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
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 support or 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.
Surgery can leave tiny scars on your legs.
The size of your varicose veins affects the type of treatment you might have. If you have larger veins, you are likely to have surgery (ligation and stripping) or less invasive procedures such as radiofrequency closure or endovenous laser treatment. Small to medium-sized varicose veins usually are treated with sclerotherapy, external laser treatment, or a minor surgery called microphlebectomy.
Procedures that are used to close varicose veins and keep them from coming back seem to work about the same. These procedures include laser treatment, radiofrequency closure, sclerotherapy, and surgery.
If you have private insurance, check to see if it covers the cost before you have any procedure. Like provincial health plans, some private insurance 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

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.)

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.

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. Lasers may be used:
- On the outside of the skin (external laser) to close off small veins near the surface.
- Inside a vein (endovenous laser) to close large veins. The doctor places a thin tube called a catheter into the vein through a small cut in the skin.
Radiofrequency closure. This procedure uses a type of energy that is different from that of a laser to close off large varicose veins in the legs. A small cut is made in the vein. The energy is directed through a thin tube placed in the cut.
Sclerotherapy. A chemical is injected into the varicose vein to damage and scar the inside of the vein. This closes the vein.

Surgery for varicose veins

How well do procedures work for varicose veins?

Laser treatment, radiofrequency closure, and sclerotherapy seem to work as well as surgery.¹

These treatments may also:

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.³

Endovenous laser treatment, radiofrequency closure, and sclerotherapy have some risks:

Blood clots may form in the veins.
You may have small scars.
Your skin may be numb where the thin tube is put in for radiofrequency closure or endovenous laser treatment.
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 colour 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:

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 have to wear compression stockings for a week or more after treatment.	You wear compression stockings . You prop up your legs on a chair or a pillow to keep blood from pooling. You do more 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. Side effects may include: Burning. Infection. Itching. Small scars. A lasting change in skin colour in the area that was treated.	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 hot and uncomfortable.

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.

"Wintering in Arizona, 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 these special panty hose that compress the leg veins, 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 blue 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 treatments like elastic stockings, but in my job that isn't practical. My doctor said that I'm a good candidate for surgery to remove the long veins and that the results should be pretty good."

— Diego, age 38

"I would like to do something about all my varicose veins, but until my youngest daughter gets out of college, we really can't afford it. I also know that treatment sometimes can cause some discoloration or scarring, which I would also like to avoid. So I wear my support hose, elevate my legs, 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:

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

Credits

By	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	David A. Szalay MD - Vascular Surgery

References

Citations

Gloviczki P, et al. (2011). The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery, 53(16S): 2S–48S. DOI:10.1016/j.jvs.2011.01.079. Accessed December 29, 2014.
Van den Bos R, et al. (2009). Endovenous therapies of lower extremity varicosities: A meta-analysis. Journal of Vascular Surgery, 49(1): 230–239.
Nesbitt C, et al. (2014). Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database of Systematic Reviews (7). DOI: 10.1002/14651858.CD005624.pub3. Accessed December 16, 2014.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.