Varicose Vein Treatment – Understanding Your Options

Reviewed by Mitchel P. Goldman, MD

Varicose veins are swollen, raised and twisty; some can be very large and dark blue in color. These unsightly veins usually occur in the legs, but they can also develop on the hands, face and breasts. An estimated 30 million Americans aged 18 to 70 have varicose veins, 50 percent of whom experience blood clots, phlebitis (inflammation of the veins) or ulcerations. Varicose veins may also cause night cramps, restless legs, pain and ankle swelling.

Now that you understand the symptoms associated with varicose veins, it's time to learn what actually causes them.

Varicose Vein Causes

All veins have one-way valves that help keep blood flowing toward the heart. When these valves become weak or damaged, blood backs up and pools in the veins, causing them to enlarge into varicose veins.

There are many potential causes of the damage that leads to varicose veins. This list includes family history, age, gender, pregnancy, excess weight, a sedentary lifestyle and leg trauma. If you are concerned about varicose veins, schedule a consultation with a doctor who has experience treating problem veins. He or she will perform a specialized ultrasound exam to map blood flow in the veins and identify where the blood is backing up and pooling (reflux). This exam can diagnose the condition and help your doctor choose the most appropriate treatment for you. Your doctor may suggest a trial period during which you wear compression stockings to see if the symptoms resolve, before moving on to more aggressive therapies.

Varicose Veins
By National Heart Lung and Blood Institute. (Varicous veins.)
[Public domain], via Wikimedia Commons

Varicose Vein Treatments

Previously, the only way to get rid of varicose veins was through invasive vein stripping and ligation surgery, through which the large vein in the leg (the great saphenous vein) is tied (ligation) and/or removed (stripping). These major surgeries are usually reserved for the most severe cases of varicose veins.

Vein stripping and ligation takes about 60 to 90 minutes to perform and sometimes requires general anesthesia. Recovery time is also lengthy, usually involving two to four weeks depending on how many veins were stripped and where they were located.

Vein stripping surgery costs between $1,500 and $3,000. This cost may not include additional fees charged by the hospital or surgical center, which can increase the cost exponentially.

Another varicose vein-removing surgery is called ambulatory phlebectomy. During this procedure, your doctor makes tiny cuts in the skin to remove small varicose veins; usually those that are closest to the surface. The in-office procedure is done with local anesthesia and is considered much less invasive than vein stripping and ligation.

Ambulatory phlebectomy may cost between $1,000 and $3,000 per leg depending on the extent and number of veins removed.

Endovenous Laser Ablation

Laser therapy for varicose veins taps into laser or high-frequency radio-wave energy to heat and close the problem vein. The veins are left in place so there is minimal bleeding and bruising. There is also no cutting involved. Laser vein surgery is less painful and involves significantly less downtime than ligation and stripping, with similar cosmetic results. These procedures are performed in the doctor's office under local anesthesia. You can leave the office and walk immediately after the procedure.

On average, endovenous laser or radiofrequency ablation costs $3,000 to $5,000 based on how much of the vein needs to be treated and where the practice is located. Large cities like New York City and Miami may charge more, as overhead is generally higher in these urban areas.


Sclerotherapy involves injecting a solution directly into the varicose vein, which irritates the lining of the blood vessel, causing its destruction. Gradually, the vessel turns into scar tissue and fades away. Not everyone with varicose veins is a candidate for sclerotherapy. Further, the treatment is not usually recommended for the great saphenous vein because it has a high recurrence rate and frequently requires multiple treatments.

Previously, sclerotherapy injections were always liquid based, but today they are also available as foam. Foam sclerotherapy involves mixing the same solution with air or carbon dioxide.

Varithena by BTG is a new foam sclerotherapy that was approved by the Food and Drug Administration in late 2013. The main advantage of foam sclerotherapy is that it displaces the blood in the vessel being treated. When this occurs, the solution directly contacts the vessel wall for a longer period of time than with a liquid solution. The enhanced solution-to-vessel wall contact allows the agent to work more effectively. The foam can also be seen via ultrasound, which helps guide and monitor the therapy.

The cost of sclerotherapy injections ranges from $500 to $650 depending on the extent of damage to the veins treated and the cost of the graduated compression stocking (around $100), which must be worn after treatment to maximize results.

Varithena foam injection costs range from $1,500 to $3,000 depending on the number of vessels treated.

The good news is that there are many effective treatments available to treat varicose veins today. Choose a qualified physician with experience treating varicose veins who can advise you on which is best based on your aesthetic or functional goals, budget and your ability to adhere to recovery instructions.

About the Reviewer of This Article

Mitchel P. Goldman, MD, is the founder and medical director of Goldman Butterwick Fitzpatrick Groff & Fabi: Cosmetic Laser Dermatology in San Diego. There, he directs the fellowship program accredited by the American Society for Dermatologic Surgery. He also is a Volunteer Clinical Professor in Medicine/Dermatology at the University of California, San Diego. Dr. Goldman is the 2013-14 President of the American Society for Dermatologic Surgery. He is founder and past president of the American College of Phlebology and past president of the San Diego Dermatological Society and the Sonoran Dermatology Society.