Varicose Veins Treatment: Your Options, From Compression to Ablation

You glance down at your legs and notice those twisted, rope-like veins bulging just under the skin. Maybe they ache by the end of the day, or maybe they just bother you in the mirror. Either way, you want to know one thing: what can actually be done about them?

The good news is that varicose veins are common and very treatable. You have real options, from simple self-care you can start today to quick in-office procedures that close the problem vein for good. Here's how varicose veins treatment works, and how to choose what's right for you.

What are varicose veins, and why do they happen?

Varicose veins are enlarged, twisted veins that you can usually see and feel near the surface of the skin, most often in the legs. They form when the tiny one-way valves inside your veins weaken, so blood that should flow up toward your heart instead pools and stretches the vein.

They are far from rare. Varicose veins affect more than 20% of the adult Western population (a range of 21.8% to 29.4%), according to clinical practice guidelines from the Society for Vascular Surgery and American Venous Forum. About 5% of adults go on to develop more advanced signs such as leg swelling, skin changes, or venous ulcers, which is one reason it's worth taking persistent symptoms seriously rather than just living with them.

How are varicose veins diagnosed?

Treatment starts with the right diagnosis. A clinician typically examines your legs while you're standing, since standing makes the veins fill and become easier to assess. To see what's happening beneath the surface, they use a venous Doppler (duplex) ultrasound.

This is a painless test that uses sound waves to map blood flow and check whether the valves in your vein are leaking, a problem called reflux. Identifying which vein is the source of the trouble is what lets your care team match you to the most effective treatment instead of guessing.

What can you do at home first?

For many people, conservative self-care is the sensible first step, especially for milder veins or while you decide on a procedure. These measures won't erase a bulging vein, but they can ease aching, heaviness, and swelling.

Compression stockings are usually the cornerstone. They gently squeeze your legs to push blood upward toward the heart, which lessens pooling and discomfort. Mayo Clinic also recommends these everyday habits:

• Wear compression stockings as advised by your clinician
• Exercise regularly to keep blood moving
• Lose excess weight if needed to reduce pressure on leg veins
• Avoid sitting or standing in one position for long stretches
• Elevate your legs above heart level for 30 minutes, three times a day

What are the medical and procedural treatment options?

When self-care isn't enough, or you want the vein gone, several minimally invasive procedures can close or remove it. Most are done in an outpatient setting and let you return to normal activity quickly.

Common options include:

• Endovenous ablation (radiofrequency or laser): A thin catheter delivers heat that seals the faulty vein shut. Radiofrequency ablation has been FDA-approved for varicose veins since 1999 and is done in the office under local tumescent anesthesia, so no general anesthesia is needed.
• Sclerotherapy: A solution is injected into the vein, scarring and closing it. The vein then fades within a few weeks as your body reabsorbs it. Foam sclerotherapy is a variation used for larger veins.
• Conventional surgery (high ligation and vein stripping): The vein is tied off and removed, now reserved mainly for cases where less invasive options aren't suitable.
• Ambulatory phlebectomy: Small surface veins are removed through tiny skin punctures.

Which varicose vein treatment works best?

Modern guidelines and trials increasingly favor minimally invasive endovenous ablation over older open surgery. The 2022 joint guidelines from the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society recommend endovenous ablation of incompetent saphenous veins over conventional vein stripping, because it causes less harm and allows faster recovery.

Durability matters too. In the CLASS randomized trial of 798 participants across 11 UK centers, both endovenous laser ablation and surgery produced better disease-specific quality of life at five years than foam sclerotherapy, and laser ablation was the treatment most likely to be cost-effective. A separate five-year trial found that the vein stayed closed or absent in 85% of people after conventional surgery and 77% after laser ablation, but only 23% after foam sclerotherapy, meaning foam carried a higher chance of the vein coming back.

The takeaway: heat-based ablation tends to offer the best balance of effectiveness, recovery, and lasting results for most people, but the right choice depends on your specific anatomy and which vein is involved. That's a conversation to have with a qualified clinician.

When should you see a doctor?

Varicose veins are often a cosmetic and comfort issue, but some signs warrant prompt medical attention. See a clinician if your veins are painful, the skin over them changes color or breaks down, you develop a leg sore or ulcer that won't heal, or a vein becomes hard, red, warm, and tender.

Sudden leg swelling, especially in one leg, along with pain can signal a blood clot and should be evaluated urgently. When in doubt, getting your legs assessed is the safest move. A simple ultrasound can tell you whether you need treatment and which option fits best.