What can you do about varicose veins, and when is surgery considered?

People who have varicose veins are often first advised to wear compression stockings. These stockings put gentle pressure on ("squeeze") the veins, which helps to transport the blood back to the heart. But it’s not clear how effective they really are. Studies have so far concluded that compression stockings can slightly reduce pain and swelling in some people.

It is not always easy to wear compression stockings every day. Some find it unpleasant – especially in warm weather.

Surgical procedures may be considered for varicose veins if

• general measures don't relieve the symptoms enough,
• complications such as venous leg ulcers occur, or
• the person finds the appearance of their varicose veins very upsetting.

Varicose veins can be surgically removed, or closed off using heat or a special foam. Removing varicose veins doesn't affect the blood supply to the legs because the blood is then "re-directed" and transported by other, healthy veins instead.

Varicose vein surgery is among the most commonly performed kinds of surgery. The main procedures to remove varicose veins are:

• Vein ligation and stripping: This involves making two cuts (incisions): One at the top of the leg just below the groin, and one behind the knee or at the ankle. The vein is first tied off or clamped where the top incision is made (vein ligation). A long wire is then inserted into the vein through the lower incision and pushed up through the vein. Finally, a button-like cap is attached to the lower end of the wire and the entire vein is pulled out through the cut near the groin.
• Phlebectomy: In this procedure, several very small cuts (just a few millimeters wide) are made along the affected vein. A small hook is then used to pull out as much of the vein as possible. Then the vein is cut and removed in several pieces. This technique is mainly used for smaller veins, like those that branch off from larger veins. It is meant to prevent the sort of scarring that can occur when bigger cuts are made during other kinds of procedures.

Surgery can very effectively relieve varicose vein symptoms: In more than 80% of people who have varicose vein surgery, it improves symptoms like pain, swelling and itching or makes them go away completely, and their legs look better afterwards.

Both of the surgical approaches can lead to pain, wound infections, bleeding, swelling, scarring and discoloration of the skin. About 15% of people who have varicose vein surgery experience one of these side effects. Serious complications such as thrombosis or nerve damage are very rare.

Sometimes new varicose veins develop after surgery. In studies that looked into this matter, 30 out of 100 people who had surgery had developed new varicose veins after two years.

It is usually possible to leave hospital on the same day as having varicose vein surgery. But it can take quite a while for the swelling to go down and the wounds to heal. In severe cases, it may take up to three weeks before you can go back to work after surgery.

In what are known as "endovenous" procedures, the vein is closed off from the inside using heat rather than being removed. This is done by making a cut in the skin and vein, inserting a thin tube ( catheter) into the vein and then pushing it along the vein. A heat-producing probe is then inserted into the vein through the catheter.

The endovenous procedures include

• radiofrequency ablation, where the heat is produced using electromagnetic waves (radio waves), and
• endovenous laser treatment, where laser energy is used to heat the vein from the inside.

Endovenous approaches are about as effective as surgery to remove the vein. They can also cause pain, bruises and scars. But compared to conventional surgery, they are less likely to lead to complications. Because of this, endovenous procedures are becoming more common nowadays.

Not all health insurers in Germany pay for endovenous procedures, though, so it's a good idea to find out beforehand whether your health insurer will cover the costs.

There is also another treatment option known as sclerotherapy. This approach involves injecting a liquid or foam into the affected vein. The drug inside the liquid or foam damages the wall of the vein, which then turns into connective tissue. This closes off the vein permanently.

Sclerotherapy is an effective treatment for varicose veins. One disadvantage of this approach is that it can lead to (sometimes permanent) discoloration of the skin at the site of injection. It may also lead to an inflammation of the vein (phlebitis).

Compared to surgery, though, other side effects such as nerve damage or bruising are much less common after sclerotherapy. People are typically able to return to their usual activities much sooner too.