The history of leg vein treatments goes back thousands of years. The Greeks recorded treating varicose veins by irritating them with a wire. Later surgery became a standard for the knottier varicose veins. Even today surgery is still used. Sometimes this can be localised vein removal like phlebectomy. At times the more invasive stripping is employed.
Sclerotherapy, by instilling an irritant solution of various types, has been used for many years. This was widely used in the English-speaking world more as a holding technique.
The European schools practised a particular sequence of treatment that has shown over time to be very effective and is now used by many others. The French developed the now widely practised ultrasound guided techniques that allow treatment of varicose veins that would previously have required surgery.
Lasers are now also being used in surface varicose vein and spider vein treatment. In the past the results were not very encouraging. Results had been patchy due to a number of factors.
The interference with the skin dilutes the effect of the light. The fact that the vessels are a circular structure, means there is not even penetration of light to all the walls of the vessels, producing an uneven response.
However the causative feeder vessels can at times be too large in diameter for the closure with even long wavelengths of laser. And the deeper seated drainage veins are well beyond the reach of laser light aimed from outside the skin.
From the beginning of the millennium people began using lasers inside the veins to treat the significant drainage veins associated with more severe varicose veins. This could be introduced by a fibre-optic cable inside the affected vein. The convoluted surface veins can then be treated with sclerotherapy.
This last technique has been widely embraced throughout the world. International vein conferences are now producing a consensus that this laser treatment inside the veins is the best approach for varicose vein treatment, with ultrasound guided sclerotherapy the next preferred and surgical stripping third for best patient outcomes.
No doubt the history of leg vein treatments will continue to grow. But at present the treatment options are very effective. Other references.