Varicose veins in the main superficial veins of the leg rarely need to be pulled out nowadays: in endovenous laser treatment, the diseased vein is sealed from the inside with heat, under local anaesthesia and through a single needle puncture. Read on to find out how the procedure works, who it suits and how it compares with radiofrequency, surgery, foam and glue.
Why varicose veins develop and when they are treated
In the leg veins, valves make sure blood flows only towards the heart. If they no longer close properly, blood falls back, the veins widen and twist near the surface: varicose veins develop. The great saphenous vein on the inner side of the leg and the small saphenous vein in the calf are most often affected. Typical symptoms are heaviness, tension, ankles that swell in the evening and night-time calf cramps. Over time, skin changes, vein inflammation and eventually a leg ulcer may develop.
Whether treatment makes sense depends on symptoms, findings and a duplex ultrasound scan. This shows which vein is leaking, how far the reflux extends and whether the deep veins are healthy. The goal is to eliminate the abnormal backflow. Fine spider veins are a different matter and are usually treated with sclerotherapy or surface lasers.
How endovenous laser treatment works
Under ultrasound guidance, the diseased saphenous vein is punctured, usually at the lower leg or knee. A thin laser fibre is advanced through a sheath to just before the junction with the deep vein. A larger volume of dilute local anaesthetic is then injected around the vein, known as tumescent anaesthesia. It numbs the area, presses the vein against the fibre and protects surrounding tissue from heat. As the fibre is slowly withdrawn, it emits laser energy; the vein wall heats up, shrinks and closes. Over the following months the body turns the sealed vein into a cord of connective tissue.
Modern systems use wavelengths absorbed mainly by water in the vein wall, often with fibres that emit light in a ring. Compared with older devices they cause less pain and bruising. Side branches, superficial varicose veins that branch off the main vein, are removed in the same session through tiny incisions (mini-phlebectomy) or treated later with sclerotherapy, depending on the findings. The procedure usually takes less than an hour, and you walk home afterwards.
Laser compared: radiofrequency, stripping, foam and glue
There are several well-studied ways to treat leaking saphenous veins. A Cochrane review concluded that laser, radiofrequency and foam sclerotherapy are at least as effective as surgery; the German guideline lists endovenous thermal ablation as an established option alongside surgery.
| Method | Principle | Anaesthesia | Features |
|---|---|---|---|
| Endovenous laser | Closure by heat | local (tumescent) | outpatient, quickly mobile |
| Radiofrequency | Closure by heat via catheter | local (tumescent) | results comparable with laser |
| Ligation and stripping | Tying off and pulling out the vein | usually general or spinal | proven, longer recovery |
| Foam sclerotherapy | Closure with a sclerosant | none | easily repeated, re-treatment more often needed |
| Vein glue | Sealing with cyanoacrylate | usually just the puncture | no tumescence, long-term data still limited |
The right method depends on the diameter and course of the vein, previous operations, other illnesses and personal preferences. Very tortuous veins cannot always be passed with a fibre. Whether a public or private insurer covers a specific method varies by country and policy and should be clarified with the practice and insurer beforehand.
Who is suitable and who is not
Good candidates are people with proven reflux in the great or small saphenous vein or a large tributary whose course allows a fibre to be passed. Treatment is avoided, or carefully weighed up, in cases of recent deep vein thrombosis, pregnancy, significant arterial disease of the legs, severe general illness, or if you will not be able to walk after the procedure. A known tendency to thrombosis must also be discussed beforehand, and a preventive injection may be given.
Side effects, aftercare and recurrence
You should walk immediately after the procedure. A compression stocking is usually recommended for a few days to weeks; the type and duration are decided individually. Common effects are bruising, a feeling of tension or pulling along the treated vein, roughly in the first one to two weeks, and palpable, slightly tender cords. Temporary numbness or tingling of the skin occurs when a nearby skin nerve is irritated by the heat, for example on the lower leg or calf. Vein inflammation, skin discolouration and skin burns are rare. Very rarely, a clot extends from the treated vein into the deep vein or a deep vein thrombosis develops; for this reason an ultrasound check after a few days is standard.
The underlying vein weakness itself cannot be removed. New varicose veins may form from other veins or from small new vessels at the treatment site. According to the German guideline, clinical recurrence within five years affects a relevant proportion of patients regardless of the method; which procedure has the fewest recurrences in the long term is not clearly established. Exercise, a healthy body weight and regular check-ups help to detect recurrence early.
Frequently asked questions
Is laser treatment for varicose veins painful?
You mainly feel the injections for the anaesthetic. Afterwards many people notice pulling or tension for a few days, which usually responds well to simple painkillers and walking.
Laser or radiofrequency – which is better?
Both thermal methods achieve comparable closure rates in studies. The choice depends more on vein anatomy and the experience of the practice than on the device.
How long do I need to wear compression stockings after vein laser treatment?
This is decided individually, usually for a few days to a few weeks. The guideline recommends initial compression without specifying a fixed duration.
When can I go back to work after the procedure?
Many people are able to work again within a few days, often sooner in desk jobs. Heavy lifting and intensive sport should be paused briefly after discussing it with your doctor.
Can varicose veins come back after laser treatment?
Yes. The treated vein usually stays closed, but the tendency to develop varicose veins remains. Recurrence is possible after every method.
Read more: Laser medicine overview · Varicose veins: causes, risks and treatment
This article is for general information only and does not replace medical advice. It is not an advertisement for any particular treatment or provider.
Sources
- Cochrane Review: Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices
- German Society of Phlebology: S2k guideline on diagnosis and treatment of varicose veins, AWMF register 037-018, 2019, under revision (German)
- S2k guideline on diagnosis and treatment of varicose veins – journal version, Springer Medizin 2022