Varicose vein treatment ranges from simple lifestyle changes to in-office procedures that take under an hour, depending on the size of the veins and the severity of your symptoms. Most people start with conservative measures like compression stockings and leg elevation. If those don’t provide relief after a few months, several minimally invasive procedures can close or remove problem veins, usually with a return to normal activities within one to two weeks.
Compression Stockings and Lifestyle Changes
For mild varicose veins, compression stockings are the first line of treatment. These graduated stockings apply the most pressure at the ankle and gradually decrease up the leg, helping blood flow back toward the heart instead of pooling in damaged veins. They come in several pressure levels:
- 8 to 15 mmHg (low compression): Available over the counter, these provide mild relief for achy, tired legs and are common among people who stand for work.
- 15 to 20 mmHg (medium compression): Also available without a prescription, this range works well for minor varicose veins, pregnancy-related leg fatigue, and preventing swelling during long flights.
- 20 to 30 mmHg (medical grade): The most frequently prescribed level for diagnosed varicose veins, chronic venous insufficiency, or mild swelling. You’ll typically need a prescription for this range.
The key to getting results from compression stockings is putting them on first thing in the morning, before you get out of bed. Overnight, your legs are elevated and swelling is at its lowest, so the stockings can maintain that reduced state throughout the day. Beyond stockings, regular exercise, periodic leg elevation, weight management, and avoiding long stretches of standing or sitting all help slow the progression of varicose veins.
Sclerotherapy for Smaller Veins
Sclerotherapy involves injecting a solution directly into the varicose vein, which irritates the vein lining and causes it to collapse and eventually fade. The procedure is done in a doctor’s office without general anesthesia. Liquid sclerotherapy works best on smaller varicose veins and spider veins. For larger veins, a foam version of the same solution is used because the foam displaces blood inside the vein more effectively, allowing better contact with the vein wall.
The concentration of the solution is adjusted based on the diameter of the vein being treated, as measured by ultrasound. Most people need multiple sessions spaced a few weeks apart. After each session, you’ll wear compression stockings to keep the treated vein closed while your body reabsorbs it.
Thermal Ablation: Laser and Radiofrequency
For larger varicose veins, particularly those involving the main trunk veins in the leg, thermal ablation has largely replaced traditional surgery. Two methods dominate: laser ablation and radiofrequency ablation. Both work by threading a thin catheter into the damaged vein through a small puncture, then using heat to seal the vein shut from the inside.
Laser ablation sends laser energy through a fiber optic cable. The energy is absorbed by blood components near the fiber tip, generating steam bubbles that cause thermal damage to the vein wall. Radiofrequency ablation uses a different approach: the catheter tip directly contacts the vein wall and heats the surrounding tissue with radiofrequency energy, causing it to shrink and seal.
Both techniques produce comparable long-term results. The practical difference for patients is pain. A meta-analysis in the Journal of Vascular Surgery found that radiofrequency ablation caused significantly less postoperative pain than laser ablation during the first three days and again between seven and ten days after the procedure. Both procedures use tumescent anesthesia, a technique where diluted numbing solution is injected around the vein, which also acts as a heat buffer to protect surrounding tissue.
Medical Adhesive (Vein Glue)
A newer option uses medical-grade cyanoacrylate adhesive to seal varicose veins shut. A catheter delivers small amounts of glue inside the vein, where its thick consistency and rapid hardening keep it in place rather than flowing with the blood. The adhesive bonds the vein walls together, and the body gradually absorbs the closed vein over time.
This method has two notable advantages over thermal ablation. First, it doesn’t require tumescent anesthesia, which many patients find uncomfortable due to the multiple needle sticks involved. Second, clinical trials have shown that patients treated with vein glue don’t necessarily need to wear compression stockings afterward, while thermal ablation patients typically do. The 12-month closure rates in the VeClose trial were comparable between the adhesive and radiofrequency ablation, making it a solid alternative for people who want to avoid both anesthesia and post-procedure compression.
Surgical Removal
Surgery for varicose veins comes in two forms: ambulatory phlebectomy and vein stripping. Phlebectomy is a minimally invasive office procedure used for bulging surface veins. The doctor marks the veins while you’re standing, then numbs the area with local anesthetic and makes tiny incisions along the vein. A small hook is used to pull the vein out in segments through these openings, which are small enough that they typically don’t need stitches. The leg is wrapped in compression bandages afterward.
Vein stripping is a more involved surgery, once the standard treatment for severe varicose veins. A doctor might recommend stripping if you’re dealing with constant pain and throbbing, skin ulcers, blood clots, or bleeding from the veins. It’s also sometimes preferred for varicose veins connected to the great and small saphenous veins, which sit deeper than the surface veins that phlebectomy targets. However, thermal ablation and adhesive treatments have replaced vein stripping for the vast majority of patients.
Recovery After Treatment
Most people return to normal activities within one to two weeks after minimally invasive vein procedures. The timeline depends partly on your job. Desk work is easier to resume quickly, while jobs that require prolonged standing or heavy lifting may require the full two weeks or slightly longer. You can self-certify for up to seven days off work; after that, you may need a note from your doctor.
Driving is safe once you can brake firmly without pain. Avoid long-haul flights for at least four weeks after your procedure, since prolonged sitting at altitude increases the risk of blood clots. Walking, on the other hand, is encouraged from day one. Short, frequent walks help circulation and reduce the chance of complications.
Insurance Coverage and Medical Necessity
Insurance, including Medicare, generally covers varicose vein treatment when it’s medically necessary, but there’s a specific process to qualify. You’ll typically need to complete a three-month trial of conservative therapy first: compression stockings, exercise, leg elevation, weight management, and avoiding prolonged immobility. If your symptoms persist after that trial, coverage kicks in when you meet at least one of these criteria:
- Pain, aching, cramping, burning, itching, or swelling during activity or after prolonged standing that’s severe enough to limit your mobility
- Recurrent episodes of superficial vein inflammation
- Skin ulcers that won’t heal
- Bleeding from a varicose vein
- Skin changes from chronic blood pooling (stasis dermatitis)
- Persistent leg swelling that doesn’t respond to conservative measures
Medicare covers one ultrasound before the procedure to map the extent of the varicose veins. A follow-up ultrasound is also covered when done within a week of thermal ablation to check for any blood clot extending into deeper veins. If your varicose veins are purely cosmetic, with no symptoms or complications, treatment is generally considered elective and won’t be covered. Documenting that three-month conservative therapy trial with your doctor is the most important step toward getting your procedure approved.