Varicose veins can be treated through a range of options, from compression stockings and lifestyle changes to minimally invasive procedures that close or remove the affected vein. Most people today are treated with outpatient procedures that take under an hour and require little downtime. The right approach depends on the severity of your symptoms, the size of the veins, and whether your insurance requires you to try conservative measures first.
Compression Stockings and Lifestyle Changes
For mild varicose veins, graduated compression stockings are the first line of defense. These stockings apply the most pressure at your ankle and gradually decrease up the leg, helping blood move back toward the heart instead of pooling in damaged veins. For varicose veins specifically, the recommended level is 20 to 30 mmHg, the most commonly prescribed range. More severe cases with significant swelling or skin changes may call for 30 to 40 mmHg stockings.
Beyond stockings, regular walking, periodic leg elevation, maintaining a healthy weight, and avoiding long stretches of standing or sitting all help reduce symptoms. These measures won’t make varicose veins disappear, but they can slow progression and relieve the aching, heaviness, and swelling that come with them.
There’s also a practical reason to start here: most insurers, including Medicare, require a three-month trial of conservative therapy before they’ll cover any procedure. That trial needs to include graduated compression, exercise, leg elevation, and weight loss if appropriate. If symptoms persist after three months, you’ve met the threshold for procedural treatment to be considered medically necessary.
Heat-Based Ablation Procedures
The most common way to permanently treat varicose veins today is thermal ablation, where a thin catheter is inserted into the damaged vein and uses heat to seal it shut. Blood naturally reroutes to healthy veins nearby. There are two main types: radiofrequency ablation (RFA) and laser ablation (EVLA).
Both are highly effective. At one month, closure rates are about 98% for either option. At one year, RFA closes the vein successfully in roughly 93% of cases and laser in about 94%. The meaningful differences show up in side effects. A large meta-analysis in the Journal of Vascular Surgery found that radiofrequency ablation produces less post-procedure pain, fewer burns, less bruising, and a lower rate of numbness or tingling compared to laser. However, radiofrequency carries a slightly higher chance of temporary skin discoloration. Radiofrequency also showed a lower rate of varicose vein recurrence overall.
The risk of a serious complication like deep vein thrombosis is low with either technique, occurring in roughly 1.5% to 1.7% of cases. That risk increases if you already have skin ulcers from vein disease. Both procedures are done in an office setting under local anesthesia, and most people return to normal activities within a day or two.
Sclerotherapy
Sclerotherapy involves injecting a solution directly into the varicose vein, which irritates the vein lining and causes it to collapse and eventually be reabsorbed by the body. It works well for smaller varicose veins and spider veins, and foam versions of the solution can treat somewhat larger veins. Most patients see about a 70% to 75% improvement in the appearance of treated veins.
Sclerotherapy is often used alongside other treatments. After thermal ablation closes the main problem vein, sclerotherapy can clean up the smaller branching veins that remain visible. The procedure takes only 15 to 30 minutes, requires no anesthesia beyond what’s in the injection itself, and involves minimal recovery.
Medical Adhesive (Vein Glue)
A newer option uses a medical-grade adhesive delivered through a catheter to glue the vein shut from the inside. Unlike heat-based methods that cauterize the vein, the glue physically holds the walls together and stops blood flow, redirecting it to healthy veins. The procedure requires only a single needle stick to insert the catheter, compared to the multiple injections of local anesthesia needed for thermal ablation.
The biggest practical advantage is that you don’t need to wear compression stockings afterward. Because the vein is immediately sealed by the adhesive, there’s no additional healing the body needs compression to support. This makes it appealing for people who find stockings uncomfortable or impractical, especially in warm climates.
Traditional Vein Stripping Surgery
Surgical removal of the vein, called ligation and stripping, is now reserved for cases where minimally invasive options aren’t suitable. You might be a candidate if you have very large varicose veins, severe venous insufficiency, active or recurring skin ulcers, or veins that are damaged where superficial veins connect to deeper ones. Recovery takes longer than catheter-based procedures, typically one to two weeks before returning to work, with restrictions on heavy activity for several weeks.
For most people, thermal ablation or sclerotherapy has replaced stripping entirely. But when vein anatomy makes catheter access difficult or the disease is advanced, surgery remains an effective option.
What to Expect During Recovery
Recovery from minimally invasive procedures is quick but comes with a few restrictions. Walking is encouraged right away and actually helps healing by promoting blood flow. High-impact exercise like running or jumping should wait until your doctor clears you, usually a few days to a week depending on the procedure. Heavy lifting typically requires a one- to two-week pause.
If you’re planning air travel after treatment, wear compression stockings for the flight. Prolonged sitting at altitude increases the risk of blood clots, and compression helps counteract that. Most people feel comfortable flying within a few days of a catheter-based procedure, but longer trips within the first week or two deserve a conversation with your treatment provider.
Recurrence After Treatment
Varicose veins can come back even after successful treatment, and this is one of the most important things to understand before choosing a procedure. A long-term study tracking patients after surgery found that recurrence at the main groin junction was just 1% at the initial follow-up but climbed to 23% by three years. At the junction behind the knee, recurrence reached 52% over the same period.
The main drivers of recurrence aren’t incomplete treatment. They’re the formation of new tiny veins that reconnect to the deep system (called neovascularization) and ongoing dysfunction in how your veins pump blood back to the heart. This means that even a perfectly performed procedure doesn’t guarantee permanent results. Wearing compression stockings, staying active, and maintaining a healthy weight after treatment all help reduce the chance of new varicose veins developing.
Insurance Coverage Requirements
Insurance will cover varicose vein treatment when it’s medically necessary, but the bar is specific. You need to have completed a three-month trial of conservative measures that failed to resolve your symptoms, and you must have at least one qualifying condition: pain or cramping severe enough to limit mobility, recurrent superficial blood clots, non-healing skin ulcers, bleeding from a varicose vein, skin changes from chronic vein disease, or persistent swelling that doesn’t respond to conservative treatment.
Treatment of veins that are purely a cosmetic concern, or symptomatic veins that haven’t gone through the required conservative trial, will typically be denied as cosmetic. Your provider will usually order a diagnostic ultrasound before any procedure to map the extent and configuration of the problem veins, and that scan is covered when medically indicated.