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THE TREATMENT REGISTRY
Patient journey

Varicose veins

By The Treatment Registry editors

Enlarged, twisted superficial veins (most commonly in the legs) caused by valve dysfunction in the venous system. Symptoms range from cosmetic concerns to aching, heaviness, swelling, skin discolouration, and in severe cases venous ulceration. Modern treatment is largely outpatient, minimally invasive, with surgical stripping now rarely performed in favour of endovenous ablation or sclerotherapy.

Treatment ladder

Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.

Conservative

  • Graduated compression stockings

    Class 2 (23-32 mmHg) stockings reduce symptoms and slow progression. First-line for symptomatic patients without severe disease.

  • Lifestyle modification (weight, exercise, leg elevation)

    Reduces venous pressure and may slow symptom progression. Not disease-modifying for established varicose veins.

Procedural

  • Endovenous laser ablation (EVLA)

    Catheter-delivered laser energy ablates the main faulty vein from the inside. Outpatient under local anaesthesia with tumescent infiltration. Now first-line for symptomatic varicose veins per modern guidelines.

  • Radiofrequency ablation (RFA)

    Similar to EVLA but using radiofrequency energy. Comparable outcomes; choice depends on operator preference and equipment availability.

  • Foam sclerotherapy

    Injection of a sclerosing foam into the vein causing it to collapse and be reabsorbed. Outpatient procedure; can treat smaller tributary veins as well as main trunks.

  • VenaSeal (cyanoacrylate glue closure)

    Catheter-delivered medical adhesive closes the faulty vein; no tumescent anaesthesia required. Increasingly used for selected cases.

Surgical

  • Vein stripping with high ligation (historic)

    Open surgical removal of the saphenous vein. Largely superseded by endovenous techniques in modern practice; reserved for selected anatomies or where endovenous techniques have failed.