Choosing a Varicose Vein Treatment

Start with the scan, not the treatment

Every option below treats a different part of the same problem — leaking valves in the superficial veins. Which one fits you is decided by a duplex ultrasound: which vein is leaking, how large it is, how straight it runs and how deep it sits. In my clinic that scan is done during the consultation itself, I read every scan, and the findings — not a standard menu — drive the recommendation.

The conservative rung

Compression stockings, leg elevation and exercise control symptoms and slow progression, but they do not close a leaking vein. They are the right first step when symptoms are mild, when surgery must wait, or when a definitive procedure is not wanted.

Closing the leaking truncal vein

This is the definitive step for most people with true varicose veins:

• Endovenous ablation (RFA/laser) — the heat-based workhorse with the longest follow-up data. Requires tumescent anaesthesia along the vein.
• VenaSeal — medical adhesive; a single puncture, no tumescent anaesthesia, usually no stockings afterwards.
• Mechanochemical ablation (MOCA) — rotating wire plus sclerosant; non-thermal, useful for below-knee segments.
• HIFU echotherapy — fully non-invasive, no skin puncture at all; newer, with evidence still accumulating, and anatomy-dependent.

Clearing the visible veins

• Microphlebectomy removes bulging surface veins through 1–2 mm nicks, often in the same sitting as ablation.
• Sclerotherapy — liquid for spider veins, ultrasound-guided foam for larger residual branches.

Where open surgery still fits

Saphenofemoral ligation and stripping — the traditional operation — is now reserved for selected cases: veins too large, too tortuous or too close to the skin for catheter techniques, or anatomy where previous treatment has changed the options. It remains a sound operation in the right vein; it is simply no longer the default.

Putting it together

Most treatment plans combine a truncal treatment with a finishing treatment, sequenced over one or two visits. If you have been quoted a single technique without a scan, the honest answer is that nobody yet knows whether it is the right one. An ultrasound-based consultation settles the question — and the plan — in one visit.