Do I Need Surgery for Varicose Veins?

Medically Reviewed by Stephanie S. Gardner, MD on September 18, 2023
4 min read

The first line of treatment for your varicose veins -- those knotty, enlarged, and discolored veins caused by blood pooling in the legs -- usually involves lifestyle changes and compression stockings.

But you might need a medical procedure. Your doctor may recommend this if your varicose veins cause:

Some people also choose to have procedures to improve the looks of their legs.

How will you and your doctor decide which procedure is the best choice for you? You will have to weigh several things in making that decision. Among them:

  • Your age and how healthy you are overall
  • The extent of your varicose veins
  • Your symptoms
  • How well you might do with specific procedures
  • Your goals and opinions about how you look and feel
  • What the doctor expects your condition to be in the future

Be sure to talk with your doctor if you have any questions about procedures in which you will be given anesthesia (a type of medical treatment that stops you from feeling pain during surgery). Your doctor may talk to you about “local anesthesia,” which blocks pain in just a small part of your body, or “general anesthesia,” in which you’re not awake during the surgery.

The procedures to treat varicose veins fall into 2 categories: those that close the veins and those that remove them altogether.

When your doctor closes off a varicose vein, your blood flow simply shifts to other veins. After the vein is closed, it fades away. Several types of procedures can do this. They include:

Sclerotherapy: Your doctor injects a solution into the vein that causes it to scar. This forces blood to change routes, going through healthier veins instead. Your collapsed vein is reabsorbed into surrounding tissue.

You can have this procedure done in a doctor’s office.

You may need several treatments -- usually 4 to 6 weeks apart -- to completely close off a vein. You won’t need anything to numb you, and the only discomfort you’ll feel will be the sensation of small needle pricks from the injections. You’ll need to wear compression stockings for a few weeks after each procedure.

Microsclerotherapy: It’s similar to sclerotherapy but uses a smaller needle to treat smaller varicose veins.

Laser therapy: Your doctor closes off the vein by zapping it with bursts of high-intensity light. They don’t need to make any cuts or use any needles in this procedure. It’s used mostly for smaller varicose veins.

Endovenous ablation therapy: For this treatment, your doctor will use a laser or radio waves to close your varicose vein. You’ll be awake during the procedure.

First, they’ll numb the area around the vein. Then they’ll make a small cut in your skin and insert a thin tube. The tube has a device that uses a laser or radio wave to create heat. That closes the vein. Most people feel only the injection of the numbing agent.

You may go home later in the day. Your leg will be wrapped in a compression bandage after the procedure.

Endoscopic vein surgery: This procedure uses a small camera on a tiny tube. Your doctor threads it into your vein through a cut in your skin. They use a surgical device at the end of the tube to close your vein.

You probably won’t need this procedure unless your varicose veins cause severe skin ulcers. If you have endoscopic vein surgery, you can go back to your normal routine within a couple weeks.

You and your doctor may decide that the best plan is to remove your varicose veins. There are 2 procedures to do that:

Ambulatory phlebectomy: This is the less complicated procedure, and it is used to remove varicose veins close to the surface of your skin. Your doctor will numb the area and remove veins through small cuts. You remain awake and generally can go home the same day.

Vein stripping and ligation: This is the solution for the most serious cases. You will be given general anesthesia so that you will not be awake during the procedure.

Your doctor will make cuts in your skin, tie off the veins, and remove them. If possible, though, the doctor will try to leave what’s called the saphenous vein, just in case you need it later for a heart bypass surgery. You might go home the same day you have the surgery. Recovery time ranges from 1 to 4 weeks.

You might feel side effects after your treatment. The most common are swelling, bruising, change in skin color, and pain.

You’re more likely to have serious side effects if you’ve had vein stripping and ligation. Although they’re rare, complications can include blood clots, severe pain, infection, and scarring.

The doctor may wrap your legs in elastic bandages after your procedure and have you wear compression stockings for a certain amount of time.

When you get home, follow instructions about exercising even though you’re sore. Inactivity raises the chance that you’ll develop a dangerous blood clot.

No matter what procedure you choose, it can only treat existing varicose veins. New ones may develop, but you can take steps to limit them, including:

  • Watch your weight
  • Exercise regularly
  • Raise your feet when you sit
  • Don’t cross your legs when you sit
  • Don’t wear tight clothes