Varithena is a minimally invasive treatment for varicose veins that uses injectable microfoam to close damaged veins from the inside. FDA-approved in 2013, it treats incompetent great saphenous veins, accessory saphenous veins, and visible varicosities both above and below the knee. Unlike heat-based vein treatments, Varithena doesn’t require a catheter threaded through the full length of the vein, which makes it an option for veins that are too twisted or tortuous for other approaches.
How the Microfoam Closes Veins
The active ingredient in Varithena is polidocanol, a sclerosing agent delivered as a 1% foam. When injected into a varicose vein, the foam displaces blood and coats the inner wall of the vessel. This prolonged contact damages the lining of the vein, causing it to collapse, seal shut, and eventually be absorbed by the body. Blood reroutes through healthy veins nearby.
The foam formulation is what sets Varithena apart from liquid sclerosants. Liquid agents get rapidly diluted by blood and deactivated by plasma proteins before they can do much work. Foam holds its shape long enough to maintain contact with the full circumference of the vein wall, making it far more effective at treating larger veins.
What Happens During the Procedure
The entire treatment typically takes under an hour and is done in an office setting with no general anesthesia. Your doctor uses ultrasound to map the veins beforehand, identifying the specific segments that need treatment and noting where superficial veins connect to the deep venous system.
During injection, your leg is elevated to about 45 degrees. This drains blood from the vein and shrinks its diameter, giving the foam better contact with the vessel wall. Before the foam goes in, your doctor may flush the vein with sterile saline to push out remaining blood. The foam is then injected through a needle or small catheter, and your doctor watches its progress on ultrasound in real time.
After injection, your doctor compresses the vein near where it meets the deep system for about five minutes. During this time, you’ll be asked to flex your foot up and down repeatedly to keep blood moving through your deep veins. The compression prevents the foam from migrating into deeper vessels where it could cause clotting issues. Your doctor then checks ultrasound again to confirm the treated vein has gone into spasm, a sign the treatment is working.
How Effective Is It
In clinical studies comparing microfoam ablation to radiofrequency ablation (a heat-based treatment), immediate closure rates were 95% for Varithena and 100% for radiofrequency. Both groups saw significant improvement in symptom severity scores after treatment. Varithena has a particular advantage for veins that are very winding or branching, since the foam can navigate curves that a rigid catheter cannot.
Medicare and most private insurers cover Varithena when medical necessity criteria are met. Coverage is generally limited to veins with a maximum diameter of 12 mm. One notable advantage in the coverage rules: unlike other ablation methods, Varithena is not excluded for veins with tortuosity or twisting that would block catheter advancement. Varicose veins that develop during pregnancy are typically not covered because most resolve on their own after delivery.
Common Side Effects
The majority of side effects from Varithena, roughly 88% in clinical trials, were mild and didn’t interfere with daily activities. The most frequently reported were bruising and limb discomfort, each occurring in about 26% of patients. Pain in the treated leg affected around 15%, and headache, muscle aches, and blood pooling at the injection site each occurred in about 10% of patients. Itching, joint pain, and mild swelling were less common, each in the 5 to 8% range.
The more serious concern is blood clot formation. In one clinical trial, ultrasound detected small venous clots in a subset of Varithena patients. These were almost entirely asymptomatic, found only because the study protocol required detailed imaging that wouldn’t happen in routine care. A small number of patients had clot extension near the junction with deep veins, and two cases of deeper clots required blood thinners. No pulmonary embolisms or neurological events were reported in any Varithena-treated patients across the trial.
Who Should Not Have This Procedure
Varithena is contraindicated for anyone with a known allergy to polidocanol or anyone who currently has an active blood clot (acute thromboembolic disease). Your doctor will also assess your deep venous system before treatment, since the procedure relies on healthy deep veins to handle rerouted blood flow.
Recovery and What to Expect Afterward
You can return to light activity the same day. Most people resume their regular diet and normal routines immediately, with a few important restrictions during the healing period.
For the first 48 hours, leave your bandages and compression stockings in place without removing them. After that, you can shower and switch to compression socks, which you’ll wear day and night for the first 14 days total. This constant compression supports the treated veins as they seal and helps prevent complications.
Avoid strenuous exercise like weightlifting or squatting for the first seven days. For the first 28 days, walk at least an hour each day, broken into 10 to 20-minute segments if needed. Avoid long stretches of sitting, including car or plane trips, and keep your legs out of direct sunlight. Standing still for prolonged periods and sitting with your legs hanging down should also be minimized during early recovery.
Some bruising and tenderness along the treated vein is normal and typically fades within a few weeks. The vein itself gradually hardens and is reabsorbed by the body over the following months, and the cosmetic improvement continues to develop during that time.