Varicose veins are twisted, enlarged, and painful veins that fill with blood. They usually develop in the legs and are raised above the surface of the skin. They aren’t life-threatening but can cause discomfort.
Traditionally, a surgery known as “vein stripping” was performed to remove varicose veins. This procedure involves making small incisions and physically pulling the veins out of the body. However, more recent technologies have been developed to remove varicose veins using minimal or noninvasive procedures. A noninvasive procedure is nonsurgical and doesn’t involve tools or equipment that cut the skin or physically enter the body. Minimally invasive procedures are performed by making tiny incisions in the skin.
There are several different minimal or noninvasive procedures available for treating varicose veins. These include:
The goal of sclerotherapy is to destroy varicose veins by injecting them with a solution called a sclerosant. The sclerosant scars the vein and causes it to collapse, forcing blood to reroute to healthier veins. Your body eventually destroys the veins, and they disappear over time. The sclerosant solution used is known as sodium tetradecyl sulfate. This type of procedure is typically used to treat small varicose veins located close to the surface of the skin called “spider veins” and to improve the appearance of the leg.
A procedure called foam sclerotherapy involves turning the sclerosant into a foam before injecting it into the vein. This process is used for larger veins because foam can cover a larger surface area than liquid.
In this procedure, radio waves, also called radiofrequency energy, are transmitted through the vein wall. Your doctor will numb the vein, use an ultrasound to see inside the leg, and then pass a wire catheter along the vein to apply radiofrequency energy along its wall. Typically, this catheter will run from the knee to the groin.
The vein wall will heat up, thicken, and contract, and eventually be reabsorbed by the body and disappear. It may take a few weeks or months to see the full results of this procedure.
Endovenous Laser Ablation
Laser ablation is similar to radiofrequency ablation, except it uses laser energy rather than radiofrequency energy. Laser fiber is inserted into the catheter, moved to the necessary location, and laser energy causes the vessel to close by heat. The vein will eventually shrink and be reabsorbed by your body over time. Radiofrequency and laser therapy are often used to treat the deeper veins of the leg.
Not all varicose veins require treatment from a doctor. On your own, you may want to try these simple things to treat them:
- weight loss
- elevating your legs while sitting
- wearing compression stockings
Noninvasive treatment may be recommended by a doctor if:
- self-care treatment isn’t successful
- the appearance of your leg is causing you distress
- you experience any pain or cramping
- blood clots form frequently
- phlebitis occurs
- ulcers or sores form
- the fatty tissue under your skin hardens due to blood pressure from the vein, which is called lipodermatosclerosis
Noninvasive treatment for varicose veins is typically performed in a doctor’s office using local anesthetic.
Before the Procedure
Be sure to tell your doctor if you’re pregnant, have any allergies, or are taking any medications, including any herbal supplements. Your doctor may ask you to stop taking aspirin, blood thinners, or any other medications that make it hard for the blood to clot a few days before the procedure.
During the Procedure
You’ll be awake during the entire procedure. Your doctor will use ultrasound to visualize the vein, and your leg will be cleaned and numbed with a local anesthetic. You may feel slight pressure when the catheter is inserted or minor stinging if a sclerosant solution is injected into the vein. If lasers are used, you’ll be required to wear protective glasses during the procedure. The closure of the vein, whether with radiofrequency or laser, shouldn’t be painful.
After the Procedure
Your legs may be wrapped with bandages to control swelling and bleeding. These bandages may need to be worn for several days. You should plan on having a friend or relative drive you home after the procedure, and you may be advised to avoid strenuous exercise for a week or two after. Acetaminophen, such as Tylenol, may be recommended for any discomfort, but you should avoid any pain relievers that may disrupt blood clotting, such as aspirin or ibuprofen.
Additionally, your doctor may have you avoid hot baths or whirlpools following the procedure. Cool showers or sponge baths with mild soap and lukewarm water are recommended.
The noninvasive treatments are generally very safe, however as with all medical procedures, there are some risks. All of the procedures carry a risk of:
- allergic reaction to the anesthesia
The risks of sclerotherapy may include:
- blood clots
- air bubbles
- small skin sores
- mild inflammation or swelling
- leaking of the solution into the surrounding tissues
Radiofrequency and Laser Ablation
The risks of radiofrequency and laser ablation include:
- damage to the vessel
- blood clots
- hematoma, or a collection of blood outside the blood vessels
- skin burns
- a sensation of tingling or prickling on the skin
- nerve injury
Typically, you can resume normal activities within a day or two after receiving treatment. You’ll need to wear compression stockings during the day for a week following treatment.
In general, noninvasive procedures are very successful and their risk of complications is low. Typically, these procedures improve the appearance of the skin on the legs or other areas. In most cases, there are no signs of scarring or bruising, but there’s a small risk that the varicose veins will return. Wearing compression stockings can reduce the risk of the varicose veins returning.