Varicose vein treatment today: from compression to modern procedures

2026-11-11

• Any varicose vein treatment starts with a phlebologist's examination and a duplex ultrasound scan of the veins.
• Compression, movement and venotonics ease symptoms but do not remove veins that are already enlarged.
• Faulty veins are now usually closed from the inside with laser, radiofrequency energy or sclerotherapy.
• Most procedures are done as outpatient care under local anaesthetic, and you can walk straight afterwards.
• Varicose veins are a long-term condition: after treatment, staying active and regular check-ups matter.

A few decades ago, the words “varicose veins” made many people think of hospital stays, general anaesthesia and long scars on the legs. No wonder people put off seeing a doctor for years, relying on ointments and home remedies instead.

Varicose vein treatment looks very different today. Most procedures are done through a needle puncture under local anaesthetic, and patients go home the same day. Here is an overview of the methods available, how they differ and why the choice should always be made together with your doctor.

Where does varicose vein treatment begin?

With an accurate diagnosis. A phlebologist will ask about your symptoms, examine your legs while you stand and refer you for a duplex ultrasound scan. The scan shows which veins and valves are not working properly, where blood starts flowing backwards and whether there are any clots. Without this map it is impossible to choose the right method. We described what to expect in our article on leg vein ultrasound.

It also helps to be clear about the goal. For some people it is relief from heaviness and swelling, for others it is preventing complications, and for others it is how their legs look. The goal, the stage of the disease, your age and your general health all shape the path your doctor will suggest.

Conservative treatment: what can it do, and what can it not do?

Conservative measures do not remove veins that are already enlarged, but they help reduce symptoms and support your legs at any stage. They are recommended both for people who are not ready for a procedure yet and for those for whom a procedure is not suitable.

• Movement. Walking, swimming, cycling and calf exercises switch on the calf muscle pump.
• Resting with your legs raised and keeping your weight in check.
• Compression stockings. They reduce swelling and heaviness and are often prescribed after procedures. Your doctor chooses the compression class, and compression is not suitable for some arterial diseases. Our article on choosing compression stockings explains how to pick the right ones.
• Venotonic medicines. International guidelines allow them to reduce pain, heaviness and swelling alongside other measures.

Phlebodia 600 (diosmin 600 mg) is an over-the-counter venotonic medicine that, according to its leaflet, is used to relieve symptoms of lymphovenous insufficiency of the lower limbs: heaviness and tiredness in the legs, pain and restless legs syndrome. The usual dose is 1 tablet a day with a meal, and a course typically lasts 2 months; if symptoms do not ease within 2 weeks, see a doctor. More details are in the official instructions. Before use, read the instructions and consult a specialist.

Sclerotherapy: how does an injection close a vein?

In sclerotherapy, the doctor uses a fine needle to inject a special medicine called a sclerosant into the vein. It damages the inner lining of the vessel, the vein seals shut and is gradually absorbed, while blood flows through healthy veins instead.

• Liquid sclerotherapy is usually used for spider veins and small reticular veins. You can read more in our article on spider veins on the legs.
• Ultrasound-guided foam sclerotherapy is also used for larger veins: the medicine is turned into a foam that makes better contact with the vein wall.

The procedure involves no general anaesthetic and no cuts, but several sessions are often needed. Afterwards you may notice bruising, temporary skin discolouration or firm areas along the vein — your doctor will explain how to keep an eye on them.

Endovenous methods: laser and radiofrequency ablation

If blood flows backwards along a large vein under the skin, the most common treatment today is endovenous thermal ablation. A thin catheter or laser fibre is passed into the vein through a puncture, a cushion of local anaesthetic solution is placed around the vein, and the wall is then heated from the inside with laser or radiofrequency energy. The vein closes and gradually turns into a thin cord.

The UK's NICE guideline and the European ESVS guidelines name thermal ablation as the preferred option for most people with incompetent large superficial veins. There are also non-thermal methods, such as sealing the vein with a special medical glue. They do not need the anaesthetic cushion but are not suitable for everyone.

When is surgery still needed?

Traditional removal of a vein through incisions is needed far less often than in the past. It is done when minimally invasive methods are not suitable, for example because of the way the veins are arranged. Individual twisted branches are often removed through tiny 1–2 mm punctures. This is called ambulatory phlebectomy, and it is often combined with laser or radiofrequency ablation.

Many people wonder where the blood will go if a vein is removed. A diseased vein is not doing its job anyway and only hinders drainage. Once it is closed, blood is redirected through healthy deep and superficial veins.

What should you know about recovery?

Modern methods are designed for a quick return to normal life. Here is what usually happens:

• most minimally invasive procedures are done as outpatient care under local anaesthetic, and you can walk straight away;
• walking is an essential part of recovery, and long bed rest is not needed;
• your doctor may recommend wearing compression stockings for a while after the procedure;
• bruising, a pulling sensation and small firm areas along the vein usually settle on their own within a few weeks;
• the doctor who treated you will tell you when you can return to sport, saunas and flights.

Remember that varicose veins are a long-term condition. Even after successful treatment, new enlarged veins may appear over time, so it helps to stay active and see a phlebologist from time to time.

Myths about varicose vein treatment

There are still many misconceptions about treating veins. Here are the most common ones:

• “Ointments and folk remedies make veins disappear.” Creams may ease discomfort for a while, but they do not remove enlarged veins.
• “You only need treatment once the veins are huge.” The decision depends on your symptoms and the ultrasound findings, not just the size of the veins. It is worth seeing a doctor as soon as symptoms appear, so treatment can be planned calmly.
• “You will have to lie in bed for weeks after a procedure.” On the contrary, modern methods rely on walking early.

The bottom line

Varicose vein treatment today is not a frightening operation but a choice between several gentle methods, from compression and venotonics to sclerotherapy, laser and radiofrequency ablation. A phlebologist's examination and a vein ultrasound will show which option suits you. Do not put off that conversation: the sooner it happens, the easier it is to keep your legs feeling light for years to come.

Sources: 1. De Maeseneer MG, Kakkos SK, Aherne T, et al. ESVS 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. 2. National Institute for Health and Care Excellence (NICE). Varicose veins: diagnosis and management. Clinical guideline CG168, 2013. 3. Instructions for medical use of Phlebodia 600 (Republic of Uzbekistan).

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