Varicose veins are swollen, twisted, painful veins that have filled with blood. They usually develop in the legs. Your doctor may be able to treat them in noninvasive ways instead of vein stripping, the traditional surgery for this problem.

Normally, valves in your veins keep your blood flowing so it does not collect in one place. But the valves in varicose veins are either damaged or missing. This causes the veins to remain filled with blood, especially when you are standing.

Nonsurgical treatments for this problem are done in a doctor’s office or clinic. You will receive local anesthesia to numb your leg. You will be awake but not feel pain.

Sclerotherapy is one common treatment. Your doctor will inject saline (saltwater) or a chemical solution into the varicose vein. The vein will harden and then disappear.

Newer methods are also being use to treat varicose veins. One is called radiofrequency ablation. Another is called endovenous laser ablation. Each of these uses intense heat to treat the vein. During these procedures:

• Your doctor will puncture the varicose vein. Ultrasound (a painless way to see inside your leg) will guide your doctor during the treatment.
• Your doctor will thread a catheter (a flexible tube) through the vein up to your groin. The doctor will inject a special solution into your vein to numb it.
• Intense heat will reach the vein through the catheter in the vein. The heat will close off and destroy the vein. The vein will disappear over time.

Most patients should try self-care treatments first. Common self-care includes keeping your leg elevated and wearing compression stockings. If self-care does not help, talk with your doctor about which treatment might be best for you.

Varicose vein therapy may be recommended for:

• Leg pain, often described as heavy or tired
• Ulcers or sores that are caused by poor blood flow in the veins
• Improving the appearance of the leg. This is a common reason for sclerotherapy.
• Lipodermatosclerosis - fatty tissue under that skin that hardens over time from high blood pressure in a vein

These treatments are generally safe. Ask your doctor about specific problems that might occur.

The risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

The risks for any procedure are:

• Bleeding
• Infection
• Bruising

The risks of endovenous laser ablation are:

• Blood clots (call your doctor if your feet or legs swell or get warm or hot)
• Pulmonary embolism (a blood clot in your lungs)
• Thrombophlebitis (inflammation in a vein with a blood clot that attaches to the vein)
• Paresthesias (prickly, tingly skin)
• Opening of the treated vein
• Skin burns from the heated catheter

The risks of sclerotherapy are:

• Vein irritation
• Blocked blood flow in the treated vein
• The solution leaks out of the vein into other tissue. This can damage surrounding tissue and cause ulcers to form.

The risks of any treatment for varicose veins are:

• Bruising or scarring
• Nerve injury
• Return of the varicose vein over time

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot several days before your treatment.

Your legs may be wrapped with bandages to control swelling and bleeding for 2 to 3 days after your treatment.

Usually patients can start their normal activities within a day or so after many of these treatments. You will need to wear compression stockings during the day for a week after treatment.

Your doctor may look inside your leg using ultrasound a few days after treatment to make sure the vein is sealed off.

These treatments are usually very successful. They reduce pain, and they also are a good way to improve the appearance of the leg. Many of these treatments cause very little scarring, bruising, or swelling.

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 68.

Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. Journal of the American Academy of Dermatology. Jan 2009;60(1).