What Is The Best Treatment For Varicose Veins?

With all the options now available, what really is the best treatment for varicose veins?  

To summarise endovenous laser is number one choice, sclerotherapy injection treatment two and surgery as third in the list.  Read on to find out why.  

What gets recommended to you may well vary with what your own doctor's knowledge is of current treatments.  Or it can depend on what the person who is treating you is able to do. 

The main three treatments for any varicose veins of significance are surgery (and there are a number of options within this too), ultrasound guided sclerotherapy, and endovenous laser therapy.  Another option, as already mentioned, is no intervention apart from wearing compression stockings whenever you are on your feet or sitting.



In the Western world surgery has been the major option for decades.  From a purely straight logical point of view you would think this would be the best option.  Once you have cut out, or more accurately tied at one end then pulled out, a varicose vein surely it is gone for good.  
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Many felt this was correct for many years.  But recent research from Dunedin University revealed an unexpected outcome.  Following up a large group of patients over five years following surgery, fifty percent had a recurrence of varicose veins at five years.  Some of these were whole new problems.  After all there is a weakness there that predisposes you to varicose veins in the first place.  But many were whole new vessels or multiple fine vessels with problems in the very place the vein(s) had been removed. 

When the first study's result was presented the initial reaction was this was poor surgery.  However the more clinics look at their long term results this same outcome is turning up repeatedly. Why?

Whenever tissue is cut the body produces certain enzymes that encourage the development of new vessels in the injured area to facilitate repair. It seems these are the cause of the strong recurrence following surgery.


Ultrasound Guided Sclerotherapy

Ultrasound guided sclerotherapy has been known to have some problems for many years.  This can be related to the technique used.  If done well, according to guidelines from the initial French, Italian and German treatments, then there there is about a twenty-five to thirty percent recanalisation of the treated trunk veins that are involved.  Untreated these and other associated tendencies can produce around a fifty percent recurrence at five years too.  

If people treated this way are followed up regularly to catch these recanalisations and these treated, the outcome is much better.


Endovenous Laser Treatment

With endovenous laser the recanalisation rate is five percent or less.  Initially it was said to be zero.  But nothing in biology is ever so clear cut.  Endovenous laser treatments began around 2000.  The history is not long yet.  But the numbers treated is accumulating year by year.

Best Treatment For Varicose Veins - International Consensus

At the recent UIP (Union Internationale de Phlebologie - or International Union of Phlebology) conference in Boston, MA, USA (September 2013) a consensus opinion was reached about the currently available treatments.  As a cross-disciplinary international gathering that has many affiliated colleges and vein groups associated with it from many countries worldwide, its opinions carry significant weight.

The consensus on the best treatment for varicose veins was in the following order:
  1. Endovenous laser treatment
  2. Ultrasound guided sclerotherapy
  3. Surgical treatment
Assuming an even playing field with each case these would be the current world-wide opinion.  There can be particular cases that lend themselves more one way than another.

At least it gives you something to base a choice on if you are seeking your best treatment for your varicose veins.

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