Varicose Veins Treatment Options in 2026

How varicose veins develop

Veins carry blood from the body back to the heart. In the legs, this means working against gravity, which veins manage with one-way valves spaced along their length and the pumping action of the calf muscles. When valves fail, blood flows backward (reflux) and pools in the superficial veins. Over time, this elevated pressure stretches the vein walls, causing the visible bulging, ropy appearance of varicose veins.

The most common source of reflux is the great saphenous vein (GSV), which runs from the inner ankle up to the groin. Less commonly, the short saphenous vein at the back of the calf, the anterior accessory saphenous vein, or perforator veins (which connect superficial to deep veins) can be the culprit. A diagnostic duplex ultrasound performed by your vascular specialist identifies which veins are causing the problem and guides treatment planning.

Conservative management — start here

For mild symptoms or when patients prefer to delay procedures, conservative care is the first step. This includes medical-grade graduated compression stockings (typically 20–30 mmHg), regular calf-pump exercise such as walking, leg elevation when possible, weight management, and avoidance of prolonged standing.

Insurance carriers typically require a documented trial of conservative therapy — usually 3 months — before approving treatment of the underlying saphenous vein. Keeping a symptom diary and following the conservative protocol carefully helps establish medical necessity for your insurance authorization.

Sclerotherapy for spider veins and small varicose veins

Sclerotherapy is the gold standard for spider veins (telangiectasias) and small varicose veins under about 4 mm. The specialist injects a sclerosant solution — commonly polidocanol or sodium tetradecyl sulfate — into the vein using a very fine needle. The solution irritates the vein lining, causing it to collapse and gradually be reabsorbed by the body.

A typical session lasts 15 to 45 minutes. Most patients need two to four sessions spaced several weeks apart for full clearance. There is minimal downtime; compression stockings are worn for several days after each session, and normal activities resume immediately. Side effects can include temporary bruising, mild discomfort, and brown pigmentation along the treated vein, which usually resolves over months.

For larger varicose branches, foam sclerotherapy uses the same medication mixed with air or carbon dioxide to create a foam, which displaces blood and stays in contact with the vein wall longer for a stronger effect.

Radiofrequency ablation (RFA)

Radiofrequency ablation closes the diseased great or short saphenous vein from the inside using controlled heat. Under ultrasound guidance and local anesthesia, the specialist inserts a thin catheter into the vein and slowly withdraws it while the tip heats the vein wall to about 120 °C. The vein walls collapse and seal shut. Blood reroutes through healthy deep veins, and the closed superficial vein is reabsorbed over months.

RFA is performed in the office in about an hour. Patients walk immediately after and return to most activities the next day, with strenuous exercise typically held for a week. Studies have shown closure rates above 95% at one year, comparable to or better than traditional vein stripping, with significantly less pain and faster recovery. Insurance coverage is broad when medical necessity is documented by ultrasound and a conservative therapy trial.

Endovenous laser therapy (EVLT)

Endovenous laser therapy works on the same principle as radiofrequency ablation but uses laser energy delivered through a thin fiber instead of an RF catheter. The procedure setup, anesthesia, and recovery are nearly identical, and outcomes are similar. Some specialists prefer one technology over the other based on training and equipment, while others choose between them based on vein anatomy.

Both EVLT and RFA are typically combined with adjunctive procedures during the same visit — phlebectomy of bulging surface branches, or sclerotherapy of small residual varicosities — for a complete cosmetic and functional result.

Stab avulsion phlebectomy

For visibly bulging varicose branches that will not be addressed by closing the saphenous vein alone, stab avulsion phlebectomy physically removes the offending veins through tiny 2–3 mm incisions. Under local anesthesia, the surgeon hooks the vein, pulls it out in segments, and the small incisions are closed with adhesive strips — no sutures.

Phlebectomy is often done in the same session as RFA or EVLT, with patients walking out wearing compression and resuming normal activity within a day or two. Healed incisions are usually nearly invisible after a few months.

Cyanoacrylate (medical glue) closure

A newer non-thermal option uses medical-grade cyanoacrylate glue (sold under the brand name VenaSeal) delivered through a catheter to seal the saphenous vein. Because no heat is used, no tumescent anesthesia is required along the vein, which simplifies the procedure and may reduce post-treatment discomfort.

Outcomes through several years of follow-up are comparable to thermal techniques. Insurance coverage is more variable than for RFA or EVLT, so confirm with your carrier and your specialist before scheduling.

When traditional vein stripping is still considered

Open surgical stripping of the saphenous vein is rarely the first choice today, but it remains an option for very large or extensively diseased veins, anatomic variants where catheter access is difficult, or patients who cannot tolerate office-based procedures. When indicated, modern technique uses an inside-out (invaginated) approach through small groin and knee incisions, with significantly less bruising than the older stripping operations.

How to choose the right treatment

The right treatment depends on which vein is the source of reflux, how large the varicose branches are, what your symptoms are, and your insurance coverage. A diagnostic ultrasound mapping is essential — without it, treatment is guesswork. Most specialists will combine techniques in a single session: closing the saphenous vein with RFA, removing the worst surface branches with phlebectomy, and treating residual spider veins with sclerotherapy in a follow-up visit.

Find a vein specialist on Vascular.com

Browse the Vascular.com directory to find vascular specialists who perform sclerotherapy, radiofrequency ablation, endovenous laser therapy, and phlebectomy in your area. Premium listings include accepted insurance plans and detailed procedure offerings to help you compare practices before booking a consultation.