page contents

Best Varicose Vein Treatment Current State Of Play

The best varicose vein treatment is a revelation to nearly everybody.  It’s like many things.  We have grown up over years with what has been done forever and feel that must be the real deal.

Especially if we have medical connections.  Or been trained in medicine whether as a doctor, nurse or other allied health person.

The best varicose vein treatment to get your best long term results has changed over the years.  Decided internationally.Looking for the absolute best long-term outcomes

The Surgical Approach - Stripping Plus....

Surgeons have trouble getting their heads around the idea.  
Admit it.  This is what most consider the ultimate solution. 

Cut it out.  It’s gone.  Isn’t it?  It must therefore be the best varicose vein treatment.

You would think so.  Sounds logical.

Now you might not like the scars.  Nor the brightly obvious smaller vessels that are left.  But somebody removed the worst ones.  Is that not enough?

It’s just was well there are investigators out there who seek to really test out assumptions.  To prove whether their biases are just that.  Or actually accurate.

A Surgical Story ....

One such was a surgeon based in Dunedin in the South Island of New Zealand.  He is the professor of surgery for the country’s first medical school.

Being a surgeon, he stripped veins.  Using the latest and best techniques of course.

Newer approaches will always use ultrasound imaging before treatment.  That way you know exactly what the underlying problems are.  You can get all the damaged vessels sorted out.

Also newer techniques involve smaller instruments and incisions.  Smaller scars and less trauma at the time.

Well, Andre van Rij, the surgery professor, followed up his team’s results over five years from the initial surgery. 

All patients had their problems mapped on ultrasound before surgery.  Surgery was always done by the same team.  Plus they had the mapping results to guide surgery.

The results?

At five years 50% of these carefully managed people had further varicose veins!  Was this the best varicose vein treatment?

Andre was no slouch and in spite of this high recurrence rate, he published his findings and presented them at international conferences.

The response?

Hardly encouraging.  Fellow surgeons questioned his methods and results.  They actually said they could not imagine why he would want to present such poor surgical outcomes.

It must have been his technique.  Right?

Interestingly as more surgeons followed up their own patients over a longer time frame - instead of the usual few months - they confirmed his outcomes.

What's Happening?

What was going wrong?

Actually this was presented by Andre van Rij in his initial results.

He had done subsequent surgery for recurrences.  In some of these cases he was able to actually create latex casts of the new vessels.

Three major types of recurrence were observed.

One was totally new vessels in another area.

That could be expected as varicose vein disease represents an underlying fault in the body as I have mentioned elsewhere.  If you have varicose veins, you are at risk of developing more.

The other two types of recurrence were the ones other surgeons had initial doubts about.

One was a whole new vessel developing right where the problem one had been removed from.  Impossible? You might think. 

Maybe he missed something.  After all it is well known some vessels are duplicated.  Removing one channel will leave the other intact. 

But all these cases had been carefully ultrasound mapped before.  Duplication would be clearly visible if the mapping was done well.

That’s one problem.

What was the other?

A mass of tiny vessels tracking right where the excised vessels had been.  Andre labeled it a medusa type collection after the Greek medusa myth.

These multiple tiny vessels might be limited in length, or quite long.  But they all had the unhealthy back flow, or reflux, of varicose veins.

An Explanation

Why would these two problems occur?

The cause is actually part of our body’s great healing mechanism. 

Any cut, laceration or injury that disrupts tissue continuity gets repaired.  Not just with the covering and lower layers.  But with blood supply as well.

New vessels need to be formed across the broken, interrupted areas.

Specially released hormones cause your body to make them.

Unfortunately in people with a predisposition to varicose veins, less than ideal performing veins occur.  New problems.  Hence a large part of the 50% recurrence rate at five years after surgery.

A fifty percent recurrence at five years does not sound great.  Like surgery might not be the best varicose vein treatment.

What is better then?

Sclerotherapy - The All Injection Approach

Well, my start in treating this common problem was with sclerotherapy, or injection treatment.  Using the innovative European methods.

Among best varicose vein treatment options is sclerotherapy or injection treatment of vessels

Historically the English speaking world had their own versions for many years.  Most of their approaches were considered as only a holding pattern.  It might delay surgery for a while.

In other words it worked temporarily.  This experience is what has coloured so many doctors’ and other medical workers’ understanding of the place or value of sclerotherapy as a best varicose vein treatment.

The European Connection

The European model was very structured and had a much higher level of success.  
Before ultrasound imaging was readily available there were some limitations.  To work well, strong concentrations of the treatment liquids needed to reach the highest pressure points involved in the presenting varicose veins.

Before widely available ultrasound, a common European approach was to surgically tie and remove a small section of these vessels at the point or points they joined the deep veins.  Known as a crossectomy.

Once good quality ultrasound imaging became available, it was possible to treat the complete problem.  The high pressure areas could be accessed with imaging to accurately place the most concentrated solutions.


By the time I had begun treating varicose veins over twenty years ago all this technology was available.  There was no need for a prior surgical session.

However there was a need to follow up straight sclerotherapy for some time.  About twenty-five percent of cases would get a breakthrough and need a touch up. 

But with regular follow up to check for and treat these, the outcomes were very good.

When compared to the surgical results, it came out ahead on the best varicose vein treatment list.

Laser Enters The Scene

Around the millennium rollover people in the UK were experimenting with using laser on these non-surface visible parts of varicose veins.

Laser symbol in best varicose vein treatment by laser inside the primary affected veinsLaser warning symbol

Again ultrasound imaging was necessary.  As well as fibre-optic tubing, or cable, to fire the laser energy inside the vessel.

The goal was to disrupt the inside surface of the vein with the heat that was generated as the laser light was absorbed by particular targets in the veins. 

In doing so it created a slightly deeper injury than the sclerotherapy solutions.  As a consequence there was a stronger healing response.  More scar tissue.

Again it avoided cutting tissue that might generate new problem veins.

At first, as occurs with many new techniques and medications, it was touted as 100% effective.  Highly improbable in any biological system.

Time has shown there might be a 5% or less chance of treated vessels recanalising or opening again.

Comparing The Big Three

With both sclerotherapy and internal laser vein treatments, there is still the underlying problem of future varicose veins occurring.  New areas of varicosities can arise.

But, even with this, the total recurrence is a lot less than occurs with surgical stripping and related treatments.

Newer Methods

What about other newer options?  Could they offer an even higher chance of being the best varicose vein treatment?

What is there?


Hard on the heels of the laser approach came an often-used, supposedly similar, technology.  RF or radio-frequency.

How does that compare for a best varicose vein treatment?

Why would it be considered?

So often I hear people putting the results of laser down to just heating effects.  Also radio-frequency is just another part of the electromagnetic energy spectrum that light is on.

Laser Vs RF Action

In reality there are a lot more properties and interactions generated with lasers.  I will cover more on this elsewhere in the near future.

Laser is attracted to specific targets.  Different wavelengths absorb into different tissues.  Radio-frequency does not have this property.  It is “colour-blind”.

Radio-frequency devices often use aiming type methods to direct their generated energy - such as uni-polar and bi-polar heads.

But the energy is still generally targeting local tissue.  If you are wanting pinpoint accuracy, there are definite limitations.

I have used it in other applications, which I will cover more on later. In summary, though, the long term results are different from those produced by laser.

It is not an approach I have embraced.  Especially when laser produces such great outcomes.  Time will reveal more about where radio-frequency really stands on the best varicose vein treatment list.

The New Glue

Then there is the new kid on the block - glue.  Or super-glue to be precise.  The medical version of it that is.

For many years it has been used for superficial lacerations in place of sutures and staples.  Especially for young children averse to needles. 

But it remains on the skin surface.  Not inside the wound.  There it would be effectively a foreign body - delaying or preventing healing.

Nevertheless versions have been used for internal body areas in very specific applications.  Much akin to shutting down vessels.

So far that has worked generally well.

Glue Questions

There are a couple of concerns. 

One is that the material remains in your body wherever it is placed.

The other is that a few people are allergic or can develop an allergy to the material.  Dermatologists are very aware of this complication.

In the last few years it has begun to be used in varicose vein applications.

Touted as a less irritating method, with less injections for those averse to needles. But also as a process that could be done without the need to wear support stockings afterwards.

But the high number of inflammatory reactions suggested not wearing stockings was not a great idea.

Also there was a fairly high recurrence rate within a few months.

Parameters for treatment have been adjusted, rather like the early use of lasers required.  It does mean more glue used with consequently higher cost.

Cost is an issue with the price of glue - medical grade, of course.  Even with the distributing companies lowering their charges more recently.

Comparing Glue And Laser

Then again laser treatments were more expensive than pure sclerotherapy and remain so.  Yet it gets used in preference.  Mainly because it is much more effective as a best varicose vein treatment.

There is no indication so far that glue is.  For real long term results some years more will be needed to reveal its true efficacy.  Especially as a best varicose vein treatment.

Even if it was as effective as lasers, which it does not appear at present it will be, there is still the concern of the long term presence of a foreign material in the body.  Along with concerns of allergic reactions.

Evaluating Newer Treatments

New treatments arise all the time in medicine.  Particularly if they are suitable for a commonly occurring condition.

The question always is: are they better than what we already have?

At this stage it would seem neither of these last two will really make it.

Maybe when assessing the ordering of best varicose vein treatment radio-frequency fits in there somewhere.  But certainly not before laser.

The Verdict - On Best Varicose Vein Treatment

In those with a long enough record of use the outcome of what is the best varicose vein treatment has been agreed to in international conferences as:

First: Laser treatments inside the vein - EVLT or EVLA - endovenous laser therapy or ablation.

Second: Sclerotherapy - full injection therapy, these days often as a foam as I discuss in the section about it.

And in third place: surgery.  Even though this is so often considered, and is understood, as the ultimate treatment.

New! Comments

Want to say or question something about this page? Leave me a comment in the box below.