Varicose Veins

Treatment

Mayo Clinic's integrated team of specialists in vascular medicine, vascular surgery, radiology and dermatology work together to determine the most appropriate varicose vein treatment for each patient. Mayo Clinic physicians have expertise and experience in all types of varicose vein treatment, including sclerotherapy, microsclerotherapy, laser surgery, endovenous thermal ablation (radiofrequency [VNUS] or laser), coil embolization, surgical vein stripping, ambulatory phlebectomy and endoscopic perforator vein surgery. Almost all procedures are performed on an outpatient basis, and patients can usually go home the day of the procedure.

Sclerotherapy/Microsclerotherapy

Sclerotherapy may be used to close small- and medium-sized varicose veins. The physician injects the veins with a solution that causes a scar to form in the vein, which forces the vein to close and the blood to reroute through healthier veins. The procedure does not require anesthesia and can be done as an outpatient procedure. This treatment for varicose veins is used most commonly, but it may require several treatments to be effective.

Microsclerotherapy is a newer type of sclerotherapy that uses improved solutions and injection techniques, which increase the success rate for removal of spider veins. A solution is injected into a vein using a very fine needle, which forces the vein to close and the blood to reroute through healthier veins.

Laser Surgery

In laser surgery, heat from a laser beam destroys the targeted veins without harming the skin. Laser surgery works most effectively on small veins. For leg vessels, laser surgery is often less effective than sclerotherapy and may have side effects that include bruising, blistering or discoloration.

Surgical Vein Stripping

Surgical vein stripping may be an option for treating larger varicose veins that have leaking valves. Vein stripping, the standard procedure for treating varicose veins for many years, involves removing a long vein (the great or the small saphenous vein) through small incisions at the groin, knee and ankle. This procedure is typically an outpatient treatment, and patients typically are able to resume normal activities within two weeks.

Endovenous Thermal Ablation

Endovenous thermal ablation is a newer minimally invasive surgery, performed to treat larger varicose veins (the great or the small saphenous vein) as an alternative to vein stripping. In the procedure, the surgeon inserts a very thin tube (catheter) into the vein and applies heat through the tip of the catheter. When the catheter is withdrawn, the heat causes the vein to collapse (ablate) and scar shut, and the blood reroutes through healthier veins. The energy source of heat applied through the catheter to cause the collapsed vein may be radiofrequency waves or lasers. Patients are able to resume activities within a few days.

Coil Embolization

In coil embolization, local anesthesia is used with ultrasound and X-ray as guides. A catheter is inserted into a larger vein (saphenous vein) in the leg or calf. A small coil is placed into the catheter and into the vein. Alcohol is injected into the vein as the catheter is withdrawn. The alcohol irritates the lining of the vein and causes it to close and scar.

Ambulatory Phlebectomy

In ambulatory phlebectomy, the physician removes varicose veins through a series of tiny skin punctures. The procedure is usually used to remove larger varicose veins in the leg. The patient is given local anesthesia. Scarring is generally minimal.

Endoscopic Perforator Vein Surgery

Endoscopic perforator vein surgery is used only when the patient has advanced to the stage of having leg ulcers. Through a small incision, the doctor inserts a thin video camera to visualize and close perforating veins, which are veins that connect superficial veins (veins located near the skin) to deep veins in the leg.

Often, to achieve optimal results, patients may receive a combination of therapies.