How are varicose veins treated?

The varicose veins are swollen, dilated, and tortuous, appearing primarily in the legs due to malfunctioning valves that impede blood flow. Although they are common and can affect both men and women, their incidence increases with age. The good news is that modern varicose vein treatment options are effective, minimally invasive, and supported by clinical research.

Depending on severity, treatments range from compression stockings to advanced medical procedures for varicose veins, such as sclerotherapy, laser ablation, or radiofrequency ablation. Each approach aims to restore healthy circulation, relieve discomfort and improve cosmetic appearance. The choice of treatment depends on several factors, including the size and location of the affected veins, symptom severity, the presence of complications such as ulcers, and the patient’s overall health status. A venous specialist typically performs an ultrasound to determine the most effective and least invasive approach for achieving lasting results.

The first approach to management of varicose veins generally focuses on non-invasive measures aimed at improving blood flow and relieving symptoms.

Compression stockings and support socks for varicose veins.

Compression or elastic stockings for varicose veins are considered an effective first‐line non-surgical treatment option. These elastic stockings work by applying the highest pressure at the ankle, with progressively lower pressure as they ascend the leg. This pressure gradient compresses the superficial veins, increases blood flow back to the heart, and reduces venous reflux. In doing so, it prevents blood stasis in the veins and helps alleviate the sensation of heaviness, pain, and edema.

Compression stockings are classified into different categories based on the pressure exerted by the garment at the ankle.

Multiple research studies have suggested that medical compression stockings significantly improved symptoms. A randomized controlled trial followed 50 patients with uncomplicated varicose veins for four weeks, comparing class I compression stockings (18–21 mmHg) to no treatment. Subjects wearing these stockings showed significant reductions in overall symptoms, pain, heaviness, and swelling, while the control group showed no improvement and even experienced increased pain. In another double-blind, placebo-controlled trial, below-knee graduated compression stockings (18–21 mmHg) were tested in 30 patients with painful varicose veins over a one-week period. The compression group revealed a significantly greater reduction in pain, as well as trends toward decreased swelling and discomfort compared with placebo stockings.

In general, compression stockings are considered safe and well tolerated, but if they are not properly fitted, they can sometimes cause skin irritation, pressure lesions, and ulcerations. If adverse effects occur, the first step is to temporarily stop wearing the stockings and assess the skin’s condition. These problems usually arise when the compression level is too high, the size is inappropriate, or the stocking develops folds that exert excessive pressure on the skin. The patient should then consult a healthcare professional to verify the fit, size, and compression class, and to rule out any underlying pathology, such as arterial disease or dermatological sensitivity.

Compression stockings are contraindicated in patients with active skin infections, a severe arterial disease or uncontrolled cardiac conditions. When properly sized and prescribed, they are generally safe and can also help relieve varicose vein symptoms during pregnancy if no contraindication exists.

Compression stockings provide a simple, noninvasive method for alleviating symptoms and slowing the progression of varicose veins; however, they do not eliminate existing veins and typically must be worn long-term.

Exercises for varicose veins.

Although exercise does not eliminate existing varicose veins, it plays a crucial role in symptom management and relief by reducing venous pressure and enhancing the calf muscle pump activity. Simple yet healthy habits such as daily walking, cycling, yoga, leg elevation, and lower-limb strengthening exercises improve blood circulation, reduce venous pressure, and alleviate swelling and heaviness. An eight-week comparative trial involving 30 women with varicose veins found that both aerobic and dryland exercises reduced pain and enhanced quality of life, with the greatest benefit observed from the dryland exercises. These findings support structured physical activity as a valuable complementary approach for symptom management.

However, certain sports are not suitable for individuals with frequent or symptomatic varicose veins. High-impact activities or exercises that involve intense exertion, such as heavy weightlifting or running, can increase pressure in the abdominal and leg veins. This often happens because people inadvertently perform a Valsalva maneuver, holding their breath and contracting their muscles during effort. This breath-hold paired with muscle contraction raises venous pressure and can exacerbate symptoms. Therefore, people with varicose veins are generally advised to opt for low- to moderate-impact activities that enhance the calf muscle pump.

Lymphatic drainage.

The lymphatic drainage manual is often used as a supportive approach to relieve leg swelling and heaviness associated with varicose veins. Although it does not address underlying venous reflux, when performed by a trained professional, this technique stimulates lymphatic circulation, reduces fluid accumulation in the lower limbs, and eases discomfort after prolonged standing. A randomized study of 70 patients with chronic venous disease found that two weeks of lymphatic drainage before surgery partially reduced leg volume by 4.2% and improved quality of life compared with no preoperative drainage. Both groups improved postoperatively, but the group receiving lymphatic drainage experienced greater symptom relief and overall functional outcomes.

Creams and ointments for varicose veins.

Topical creams and ointments intended for varicose veins relieve symptoms such as heaviness, warmth, and mild edema, but they cannot strengthen the venous wall or reverse varicose vein development. These products often contain plant-derived active ingredients such as escin (horse chestnut), Centella asiatica, witch hazel, or flavonoid-rich extracts. Some clinical studies suggest that escin-based gels can reduce leg volume and discomfort when applied regularly, particularly in early-stage venous insufficiency.

A pilot study involving 32 adults with chronic venous disease evaluated a topical cream containing 10% witch hazel, 2% horse chestnut extract, and 2% rutin, self-applied at home for six weeks. Baseline and follow-up assessments demonstrated excellent participant adherence and an improvement in the Venous Clinical Severity Score. These preliminary findings suggest that plant-based topical formulations may help reduce the clinical symptoms of varicose veins. However, these effects remain modest and are concentration-dependent.

Current research data do not provide solid or consistent conclusions regarding the long-term efficacy of topical treatments, and their benefits appear to be primarily symptomatic rather than curative.

Dietary supplements for varicose veins.

Several venotonic agents are used to relieve the symptoms of varicose veins and chronic venous insufficiency, but they differ in their regulatory status and the robustness of the evidence. Diosmin–hesperidin combinations (often at a dose of 450 mg/50 mg per day) are the most extensively studied venotonics and have been shown to reduce the sensation of leg heaviness, edema, and cramps in chronic venous insufficiency. This combination enhances venous tone by promoting contraction of the smooth muscle in the venous wall, which decreases venous distension and improves venous return.

Other oral herbal supplements are also used to support venous health, with varying levels of evidence. Horse chestnut seed extract (standardized to 50–150 mg of escin per day) has demonstrated improvements in edema and pain in several clinical trials. This extract is rich in escin, a compound that decreases capillary permeability and stabilizes endothelial function, thereby limiting fluid leakage and edema. Additionally, escin and flavonoid-rich extracts exert anti-inflammatory effects by reducing leukocyte activation and endothelial inflammation, which alleviates venous hypertension and tissue damage. Another extract from French maritime pine bark has also shown a reduction in leg swelling and capillary leakage in small-scale studies. This extract decreases capillary leakage and limits edema. Furthermore, it improves microcirculation by increasing red blood cell deformability and reducing platelet aggregation, promoting smoother blood flow and better tissue oxygenation.

Ginkgo biloba is a widely used plant extract with antioxidant, anti-inflammatory, and microcirculatory effects. Experimental studies suggest that it may protect endothelial cells, reduce platelet-activating factor and improve hemorheological properties, which is relevant in chronic venous insufficiency. However, clinical data on using Ginkgo biloba alone for varicose veins remain limited. Most supportive evidence comes from venotonic combinations pairing Ginkgo biloba with agents such as troxerutin and heptaminol, which have shown improvements in pain, heaviness, cramps, and leg edema when used alongside compression therapy and lifestyle measures. Because Ginkgo can modulate platelet function, it should be used with caution in individuals on anticoagulants, those with bleeding disorders, or before surgery, and medical advice is recommended before use.

Although dietary supplements can alleviate symptoms, they do not eliminate varicose veins and should be used only as a supportive therapy under medical supervision.

When conservative measures—such as compression therapy and lifestyle modifications—are insufficient to alleviate symptoms or slow the progression of varicose veins, minimally invasive procedures are often considered the next step in their management.

Sclerotherapy for varicose veins.

Sclerotherapy is one of the most commonly used non-surgical treatments for varicose veins and has been performed in its modern form since the 1940s. The procedure involves injecting a liquid or foam sclerosing agent, most often polidocanol or sodium tetradecyl sulfate, directly into the affected vein. These agents disrupt the venous endothelium, causing the vessel walls to collapse, occlude, and gradually convert into a fibrous cord that is reabsorbed by the body. Blood flow is then redirected to healthier veins.

Although sclerotherapy effectively improves symptoms and the appearance of visible veins, it does not correct the underlying problem of venous reflux or valvular weakness. Consequently, adjacent superficial veins may dilate over time, and recurrence is possible even after successful treatment. A 2021 Cochrane review of 28 clinical trials involving more than 4,200 patients showed that sclerotherapy enhances cosmetic outcomes, improves quality of life, and reduces residual veins compared to placebo. However, recurrence rates could not be precisely quantified due to variations in follow-up duration and in definitions of evaluation criteria. Long-term studies confirm that repeated sessions or additional treatments are often necessary.

The side effects associated with sclerotherapy are generally mild and temporary, such as bruising, itching, or skin discoloration, while rare complications include superficial thrombophlebitis or, very rarely, deep vein thrombosis. Sclerotherapy is contraindicated in cases of pregnancy, acute deep vein thrombosis, severe peripheral arterial disease, known allergy to sclerosant agents, and in situations where mobility is limited.

Although sclerotherapy effectively closes the treated vein, it does not cure the underlying chronic venous insufficiency, which is why recurrence can occur even after successful treatment.

Laser therapy for varicose veins.

Endovenous laser ablation (EVLA) is a minimally invasive procedure used to treat varicose veins by delivering laser energy into the dilated vein, causing it to collapse and close. A thin catheter is inserted into the vein under local anesthesia, and a laser fiber is then introduced. Upon activation, the laser delivers controlled thermal energy along the vein wall, resulting in its retraction, collapse, and sealing. Blood is naturally redirected to healthy veins. Typically, the procedure takes 30 to 45 minutes and is performed on one vein per session. Patients with multiple varicose veins require multiple sessions.

According to a meta-analysis, varicose vein ablation achieves a success rate of approximately 94.5%, with recurrence in 10.3% and recanalization in 3.6% of treated veins. The most common side effects after EVLA are mild and temporary, such as skin bruising, pain, swelling, or induration along the treated vein. In rare cases, more serious complications, such as deep vein thrombosis (0.6%) or pulmonary embolism (0.4%), can occur, but they remain uncommon when the procedure is properly performed.

EVLA is considered an effective and safer alternative to open surgery, often offering faster recovery and fewer side effects.

Radiofrequency ablation for varicose veins.

Radiofrequency ablation of varicose veins is a modern, minimally invasive procedure performed using controlled thermal energy to obliterate damaged or dilated veins. A thin catheter is inserted into the affected vein, and radiofrequency energy is applied to the vein wall, causing it to contract, collapse, and eventually be reabsorbed by the body. Once obliterated, blood flow naturally reroutes through healthy veins, improving circulation and reducing visible swelling and discomfort. Most patients require only a single session per vein, although additional sessions may be necessary if multiple veins are affected.

Among all varicose vein treatment options, radiofrequency ablation (RFA) has established itself as the method of choice because it is less painful, safer, and allows for faster recovery. Studies have shown that it delivers results that are just as effective, if not superior, to older techniques such as endovenous laser ablation (EVLA) and open surgery. According to several clinical reviews, RFA achieves a success rate exceeding 90% of vein closure and significantly reduces post-procedural pain, bruising, and nerve irritation compared with laser procedures. Common temporary side effects include bruising, swelling, a sensation of tightness, or mild skin numbness. This method is contraindicated in cases of pregnancy, active deep vein thrombosis, superficial vein thrombosis, severe peripheral arterial disease, local skin infection at the access site, allergy to anesthetic agents, or any condition preventing early mobilization after the procedure.

Recent research comparing radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) has shown that patients treated with RFA experience lower pain levels, require fewer analgesics, and suffer less bruising and skin burns. Thus, RFA combines excellent cosmetic outcomes with lasting relief of symptoms such as heaviness, swelling, and discomfort..

Surgical treatments for varicose veins.

When addressing varicose vein correction, surgical treatment is considered a traditional option, generally reserved for cases where less invasive techniques, such as radiofrequency or laser ablation, are not suitable or have not been effective. The goal of surgery is to remove or ligate the damaged veins to restore healthy blood flow. Common procedures include ligation (tying off the affected vein at its source), vein stripping (removal of a long segment of the great saphenous vein, usually up to the knee), and ambulatory phlebectomy (removal of small superficial veins through tiny skin incisions). Modern techniques often use inversion extractors and vein hooks, reducing tissue trauma and improving cosmetic outcomes.

Recent research has shown that varicose vein surgery, including stripping and phlebectomy, remains safe and effective even in elderly patients. A large US database study of more than 48,000 patients found a very low complication rate of about 2.5% and an extremely low mortality rate (0.02%), including among those aged 80 and over. The results also highlighted an increasing number of older patients undergoing these procedures, often for more advanced cases such as venous ulcers. This study confirmed that age alone is not a risk factor for adverse outcomes. However, patients with conditions such as renal insufficiency or open wounds before surgery may face increased risks and require rigorous management.

Although surgical treatment of varicose veins provides significant relief from pain, swelling, and cosmetic concerns, it is gradually being replaced by endovenous treatments such as radiofrequency ablation and laser ablation, which offer comparable results with less postoperative pain and faster recovery.

• GOUGH M. J. & al. Treatment options for primary varicose veins—a review. European Journal of Vascular and Endovascular Surgery (2005).

• MARSTON W. A. & al. Inflammatory cytokine levels in chronic venous insufficiency ulcer tissue before and after compression therapy. Journal of Vascular Surgery (2009).

• DAVIES A. H. & al. Randomized clinical trial of VNUS® ClosureFAST™ radiofrequency ablation versus laser for varicose veins. Journal of British Surgery (2010).

• MOLSKI S.& al. Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: a randomized controlled trial. Archives of Medical Science (2013).

• DAVIES A. H. & al. Graduated compression stockings. Canadian Medical Association Journal (2014).

• FERAGALLI B. & al. Management of varicose veins and chronic venous insufficiency in a comparative registry with nine venoactive products in comparison with stockings. International Journal of Angiology (2017).

• GABRIELE S. & al. LivRelief varicose veins cream in the treatment of chronic venous insufficiency of the lower limbs: a 6-week single arm pilot study. PLoS One (2018).

• TSOLAKIS I. A. & al. Acute effects of graduated elastic compression stockings in patients with symptomatic varicose veins: a randomised double blind placebo controlled trial. European Journal of Vascular and Endovascular Surgery (2018).

• BAPTISTA-SILVA J. C.& al. Injection sclerotherapy for varicose veins. Cochrane Database of Systematic Reviews (2021).

• CHAAR C. I. O. & al. Trends of hospital-based surgery for varicose veins in the elderly. Journal of Vascular Surgery: Venous and Lymphatic Disorders (2021).

• MOSES S. L. A comparative study between aerobic exercise and onshore exercise on severity of pain and quality of life in women with varicose veins. International Journal of Medical and Exercise Science (2021).

• CHAWLA P. & al. A comprehensive review on varicose veins: preventive measures and different treatments. Journal of the American Nutrition Association (2022).

• GERBUTAVIČIENĖ R. J. & al. Ginkgo biloba, troxerutin and heptaminol chlorhydrate combined treatment for the management of venous insufficiency and hemorrhoidal crises. European Review for Medical & Pharmacological Sciences (2022).

• TARDEH Z. & al. Endovenous laser ablation for varicose vein treatment: a systematic review and meta-analysis. Indian Journal of Surgery (2023).

• QIN X. & al. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins: A meta-analysis. Journal of Vascular Surgery: Venous and Lymphatic Disorders (2024).

• RABE E. & al. Efficacy of medical compression stockings class I on the reduction of symptoms in patients with uncomplicated varicose veins. VASA (2024).

• SEIFALIAN A. M. & al. Effect of graduated compression stockings on limb oxygenation and venous function during exercise in patients with venous insufficiency. Vascular (2024).