How Varicose Veins Are Treated

Medically reviewed by Danielle McNeil, D.P.M

Varicose vein treatments decrease symptoms, prevent complications such as leg pain, blood clots, or sores (ulcers), and sometimes eliminate them.

For some people, varicose veins cause no symptoms, and treatment aims to improve their appearance. While conservative treatments can help improve symptoms and keep varicose veins from worsening, procedures are usually needed to eliminate varicose veins.

This article discusses different ways to treat varicose veins, including home remedies, lifestyle changes, medication, and surgical procedures.

Home Remedies and Lifestyle Changes

For some people, at-home treatments and lifestyle changes may improve symptoms and keep varicose veins from worsening. Home remedies and lifestyle changes that may improve varicose veins include:

• Wearing compression stockings

• Elevating your legs several times a day for about 15 minutes

• Avoiding sitting or standing for long periods

• Getting plenty of exercise

• Avoiding high heels or tight clothes, especially around the waist, upper thighs, and legs

While at-home treatments and lifestyle changes can improve symptoms and prevent new varicose veins, they cannot eliminate existing ones.

Compression stockings put gentle pressure on the leg to help decrease swelling and keep blood from pooling. The three types are:

• Support pantyhose: Provide the least amount of pressure

• Over-the-counter (OTC) compression hose: Provide some pressure

• Prescription-strength compression hose: Provide the greatest amount of pressure and usually need to be fitted by a trained employee at a medical supply store or pharmacy

OTC and Prescription Therapies

Phlebotonics are natural flavonoids and are sometimes used to treat varicose veins. Phlebotonics usually are sold as dietary supplements. Diosmiplex and horse chestnut seed extract are phlebotonics that treat varicose veins.

While there is evidence that certain phlebotonics can reduce edema (swelling) and other symptoms, research shows that the majority have little or no effect on improving quality of life. Research is lacking on how safe and effective most are for varicose vein treatment.

Diosmiplex

Vasculera (diosmiplex) is the only prescription formula phlebotonic available in the United States for chronic venous insufficiency, a blood circulation disorder that leads to varicose veins and other conditions. It is derived from orange rinds and categorized as a medical food, not a drug.

Diosmiplex improves symptoms such as leg swelling, aching, and night cramps. It's also effective in healing sores under 10 centimeters.

Diosmiplex is usually prescribed at a dosage of one 630-milligram tablet per day, and it may take between four weeks and several months to see symptoms improve. The most common side effect is gastrointestinal upset; serious side effects are rare.

Horse Chestnut Seed Extract

Horse chestnut seed extract (HCSE) has been shown to improve symptoms such as calf spasms, pain, fatigue, and leg swelling, with the effects believed to be due to HCSE’s active component, aescin.

Research has shown HCSE to be safe, well-tolerated, and as effective as compression therapy in relieving varicose vein symptoms. The typical dosage used for HCSE is 300 milligrams twice daily for two to 16 weeks.

Surgeries and Specialist-Driven Procedures

Several methods are used to treat varicose veins, including noninvasive procedures, laser therapy, and specialist-driven surgery.

Sclerotherapy

Sclerotherapy is the most common procedure for varicose veins. It treats both spider veins and small varicose veins. During the procedure, a chemical is injected into different areas of the veins using ultrasound imaging for guidance. The chemical irritates the vein walls, causing them to stick together so blood can no longer flow through the vein.

This procedure is typically done in a medical office without anesthesia, and most people return to work and other activities the next day. Taking daily walks and wearing compression stockings for two to three weeks is needed to prevent possible side effects.

Complications from sclerotherapy include skin color changes and, in rare cases, blood clots, nerve damage, serious allergic reaction, or stroke.

Endovenous Ablation

In endovenous ablation, guided by ultrasound imaging, your healthcare provider places a fiber or electrode into the vein through a small incision. Radiofrequency or laser energy is then used to heat the vessel, causing it to close.

The procedure can be done on larger varicose veins and is typically performed on an outpatient basis using local anesthesia. Normal activities can usually be resumed immediately after the procedure, although compression stockings may need to be worn during recovery. It may take up to one year for the vein to disappear.

Common side effects of endovenous ablation include bruising, pain, and changes in skin color. Serious side effects such as numbness, skin burns, and blood clots are rare.

Laser Treatment

Laser treatment was once only used to treat spider veins on the face, but newer technology has
made it an effective treatment for smaller varicose veins. During the procedure, laser light is applied to the skin on the area over the vein. The laser light then fades the vein away without causing damage to the skin.

Small spider veins may disappear immediately after treatment, while varicose veins usually darken and take one to three months to disappear. Three or more treatments might be needed to get complete results.

Surgery

Surgical options are typically only used for people with severe varicose veins who are not candidates for other treatments. While severe side effects are rare, surgeries for varicose veins can have complications that include infection, nerve damage, bruising, pain, and changes in skin color.

Ligation and stripping are the most well-known surgical procedures for varicose veins, and involve surgically tying shut then removing veins through incisions in the skin. The surgery is on an outpatient basis (you go home the same day of the procedure) and uses a general anesthetic. Full recovery takes one to four weeks. Though ligation and stripping were once common treatments, the procedures are now only done in severe cases.

Microphlebectomy, which uses special tools inserted through small incisions to remove varicose
veins, is also sometimes done alone or with vein stripping. Microphlebectomy can be used on small branches of varicose veins that don’t respond to other treatments or require additional treatment.

Summary

Treatment for varicose veins has significantly improved thanks to modern technological advances. While at-home, over-the-counter, and prescription treatments can improve symptoms and prevent varicose veins from worsening, sclerotherapy or endovenous ablation are sometimes needed to eliminate varicose veins.

Although surgical procedures were once common treatments for varicose veins, they are now only used in extreme cases. This is mainly because they require longer recovery than less invasive interventions and have more potential side effects.