Should I have a surgical procedure for varicose veins?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Your decision about whether to have a surgical procedure for varicose veins involves several issues, including the severity of your symptoms, concerns about how you look, and the risks of having surgery. Consider the following when making your decision:

• You may want to try self-care measures, such as wearing compression stockings, elevating your legs frequently, exercising, and losing excess weight, before you consider a surgical procedure.
• The size of your varicose veins affects your treatment options. If you have larger varicose veins, generally, you are treated with surgery (ligation and stripping) or radiofrequency closure technique. Small to medium-sized varicose veins are treated with sclerotherapy or laser.
• Laser therapy and radiofrequency closure are newer techniques. Before undergoing these procedures, ask your doctor about their risks and benefits and about your doctor's success rate in performing them.
• Before you consider any procedure, check with your insurance to see if it covers the cost. Some policies do not cover procedures that are considered cosmetic.

Medical Information

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What are varicose veins?

Varicose veins are twisted, enlarged veins near the surface of the skin. Varicose veins most commonly develop in the legs and ankles.

How are varicose veins treated?

For most people, home treatment is effective in relieving symptoms of varicose veins. Exercising, wearing compression stockings, and elevating the legs are common self-care measures. Sometimes being overweight can make varicose veins worse. Your doctor may recommend that you lose weight.

If you have bothersome symptoms despite home treatment, you may want to consider a surgical procedure. The following procedures can usually be performed in your doctor's office or clinic:

• Sclerotherapy. In this procedure, a chemical (sclerosant) is injected into the varicose vein to damage and scar the inside lining of the vein, causing the vein to close.
• Laser therapy. Newer techniques using deeper-penetrating lasers have enabled effective closure of slightly larger leg veins. Laser therapy scars and closes off varicose veins.
• Microphlebectomy, or stab avulsion. In this procedure, several tiny incisions are made in the skin through which the varicose vein is removed. Stitches usually are not required.
• Radiofrequency closure technique. Radiofrequency energy (instead of laser energy) is used to close off large varicose veins in the leg.

Vein ligation and stripping is a standard surgical treatment for varicose veins. During this surgery, one or more incisions are made over the vein, and the vein is tied off (ligated) and all or the diseased part of the vein is usually removed (stripped). This surgery usually requires general or spinal anesthesia.

What are the risks of surgical procedures for varicose veins?

The risks of sclerotherapy, endovenous laser therapy, and the radiofrequency closure technique for varicose veins include:

• Recurrence of varicose veins (fairly common).
• Blood clots in the veins.
• Small scars.
• Numbness at the site of catheter insertion (radiofrequency closure technique only).
• Bleeding sores (ulceration).
• In rare cases, allergic reaction to the solution injected into the vein (sclerotherapy only).
• In rare cases, permanent changes in the color of the skin or the formation of tiny new blood vessels (matting) in the area that was treated.

The risks of vein ligation and stripping surgery include:

• Bleeding.
• Infection.
• Numbness in the leg, which is usually minor.
• Small scars where the vein was removed.
• Risks of anesthesia.
• Decreased circulation in the affected leg, resulting in swelling.

People with a history of blood clots in the deep veins (deep vein thrombosis) or blood clots and inflammation in a small vein near the surface of the skin (thrombophlebitis) may be at greater risk for problems related to varicose vein surgery.

If you need more information, see the topic Varicose Veins.

Your Information

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Your choices are:

• Try self-care measures to manage your symptoms, including elevating your legs, exercising, wearing support or compression stockings, and losing weight.
• Choose a surgical procedure to close or remove your varicose veins.

The decision whether to have a surgical procedure takes into account your personal feelings and the medical facts.

Deciding about surgery for varicose veins

Reasons to have a surgical procedure

Reasons not to have a surgical procedure

You are bothered by varicose vein symptoms. Sometimes symptoms persist, despite self-care measures. Newer outpatient techniques, including radiofrequency closure and laser, offer promising results with fewer risks. Are there other reasons you might want to have a surgical procedure for varicose veins?

Varicose veins are more of a cosmetic problem than a health problem. Symptoms often can be treated with self-care measures, such as wearing compression stockings, elevating legs, exercising, and losing weight. Surgical procedures have risks, including recurrence of varicose veins, scarring, and blood clots. Newer techniques, including radiofrequency closure and laser, should be performed by experienced practitioners and may be expensive. Are there other reasons you might not want to have a surgical procedure for varicose veins?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgical procedures for varicose veins. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My legs frequently ache and sometimes swell.	Yes	No	NA*
Having nice-looking legs is important to me.	Yes	No	Unsure
My insurance will cover these procedures.	Yes	No	Unsure
I have to stand for my job, and my legs ache.	Yes	No	NA
I can take time during the day to elevate my legs.	Yes	No	NA
Wearing compression stockings bothers me.	Yes	No	NA
I'm going to try to lose weight.	Yes	No	NA
I've tried to lose weight but can't.	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have a surgical procedure for varicose veins.

Check the box below that represents your overall impression about your decision.

Leaning toward having a surgical procedure

Leaning toward NOT having a surgical procedure

Return to the topic Varicose Veins.

Credits

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Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	David A. Szalay, MD - Vascular Surgery
Last Updated	February 11, 2008