Varicose veins can be managed through a combination of daily habits, compression therapy, and medical procedures depending on their severity. For mild cases, consistent leg elevation and compression stockings often provide meaningful relief. For veins that cause persistent pain, swelling, or skin changes, minimally invasive procedures now close off problem veins with success rates above 93% and recovery times measured in hours rather than weeks.
Why Varicose Veins Get Worse Over Time
Veins in your legs contain one-way valves that push blood upward toward the heart. When those valves weaken or fail, blood flows backward and pools in the vein, stretching the vessel wall. That stretched, bulging vein is what you see at the surface. The underlying problem is a pressure imbalance: high pressure from the deep vein system gets transmitted into the superficial veins near the skin, dilating them further.
This isn’t just a cosmetic issue. At the cellular level, the pooled blood creates a low-oxygen environment in the vein wall. Over time, this triggers structural changes in the vessel, including thickening and stiffening of the vein wall. Left unmanaged, varicose veins can progress from visible bulging (the stage most people notice) to chronic swelling, skin discoloration, and in severe cases, open sores near the ankle that are slow to heal. That progression is why early management matters even when symptoms feel minor.
Leg Elevation and Exercise
Elevating your legs above heart level for about 15 minutes, three to four times a day, helps counteract the gravitational pressure that worsens varicose veins. You can prop your legs on a stack of pillows while lying on a couch, or rest them against a wall. The key is getting your feet and calves genuinely higher than your chest, not just resting them on an ottoman at hip height.
Walking is the single most helpful exercise because your calf muscles act as a pump, squeezing blood upward through the veins with each step. Swimming and cycling work similarly. Avoid long stretches of standing or sitting in one position. If your job keeps you on your feet or at a desk, take short walking breaks every 30 to 60 minutes and flex your ankles periodically to engage that calf pump.
How Compression Stockings Work
Compression stockings apply graduated pressure to your legs, tightest at the ankle and gradually loosening toward the knee or thigh. This external squeeze helps push blood upward and prevents it from pooling in damaged veins. They don’t fix the underlying valve problem, but they can significantly reduce pain, swelling, and the heavy, achy feeling that worsens throughout the day.
Stockings come in several pressure levels, measured in millimeters of mercury (mmHg):
- 15 to 20 mmHg: Light support for tired, mildly achy legs, travel, or preventing varicose veins during pregnancy.
- 20 to 30 mmHg: The most commonly prescribed level. Used for existing varicose veins, chronic leg fatigue, mild swelling, and after procedures like sclerotherapy.
- 30 to 40 mmHg: For moderate to severe varicose veins, significant swelling, or after a deep vein thrombosis.
Most people managing varicose veins will use 20 to 30 mmHg stockings. The 30 to 40 range typically requires a prescription. For compression to work, you need to put the stockings on first thing in the morning before swelling starts and wear them throughout the day. They lose their effectiveness over time and generally need replacing every three to six months.
Sclerotherapy for Smaller Veins
Sclerotherapy involves injecting a chemical solution directly into the vein, which irritates the vessel lining and causes it to collapse and eventually be absorbed by your body. It’s most effective for spider veins and smaller varicose tributaries. The two main agents used are polidocanol and sodium tetradecyl sulfate.
The solution can be injected as a liquid or as a foam. Foam sclerotherapy is substantially more effective for varicose tributaries: one study found complete closure in 92.7% of veins treated with foam compared to 71.8% with liquid. For reticular veins, the gap was even wider, with foam achieving a 94.4% success rate at three months versus 53% for liquid. Foam works better because it displaces blood inside the vein, allowing the chemical to make fuller contact with the vessel wall. Sessions typically take 15 to 30 minutes, and you may need multiple treatments depending on the number of veins involved.
Thermal Ablation Procedures
For larger varicose veins, particularly the great saphenous vein running along the inner thigh, thermal ablation has become the standard treatment. A thin catheter is inserted into the vein through a small puncture, then heat is used to seal the vein shut from the inside. Blood reroutes through healthy veins nearby.
Two types dominate: radiofrequency ablation (RFA) and laser ablation. Both achieve high closure rates. At one month, both exceed 98%. At one year, RFA closes the vein in about 93% of cases and laser in about 94%. The practical difference between them comes down to side effects. A large meta-analysis found that radiofrequency ablation causes less postoperative pain, fewer burns, and less bruising than laser. It also showed a lower recurrence rate in studies from 2016 onward. Laser, on the other hand, carries a slightly lower risk of skin pigmentation changes afterward.
Both procedures are done under local anesthesia in an outpatient setting. You walk out the same day and can typically return to normal activities within a day or two, though strenuous exercise is usually off limits for one to two weeks.
Medical Adhesive (Vein Glue)
A newer option called VenaSeal uses a medical-grade adhesive to seal the vein shut instead of heat. A catheter delivers small amounts of glue along the length of the vein, and external pressure holds the walls together while it sets. Because no significant heat is involved (the glue generates only about 40 to 45 degrees Celsius, close to body temperature), tumescent anesthesia along the vein isn’t required. In a study of over 1,500 patients, about 13.5% didn’t need any anesthesia at all.
Closure rates are comparable to radiofrequency ablation, ranging from 93 to 100% across studies, with follow-up data now extending beyond eight years. The major advantages are comfort-related: pain scores and neurological side effects like numbness are minimal, and over 90% of patients in one large series didn’t need compression stockings afterward. All patients left the office within 30 to 120 minutes of the procedure. The tradeoff is that some people experience a mild inflammatory reaction along the treated vein in the weeks following, which typically resolves on its own.
Choosing the Right Approach
The right management strategy depends on how far your varicose veins have progressed. Veins that are visible but cause only occasional heaviness or aching often respond well to compression stockings, regular exercise, and leg elevation. This conservative approach won’t reverse the veins, but it can keep symptoms from worsening and slow progression.
If you’re experiencing persistent pain, noticeable swelling by the end of the day, skin changes near the ankle (darkening, thickening, or itching), or if conservative measures aren’t providing enough relief, a procedure is worth discussing with a vascular specialist. Spider veins and smaller tributaries are typically treated with foam sclerotherapy. Larger veins involving the saphenous trunk are treated with thermal ablation or vein glue. These approaches can be combined in a single treatment plan when both large and small veins are involved.
Weight management also plays a role. Excess abdominal weight increases pressure on leg veins, which is one of the mechanisms that makes valves fail in the first place. Reducing that pressure through weight loss won’t repair damaged valves, but it can slow the development of new varicose veins and improve the results of any treatment you pursue.