Which varicose vein treatment is best?

Every technique, and why the choice matters less than the scan

Patients often arrive having read that one technique is the modern one and the rest are outdated. It is not how the field works. There are six ways to close a vein and they treat different veins, so the useful question is which one your leg needs, not which one is newest.

This is a vein practice. Leg veins, hand veins and facial veins, and nothing else, since 2010. That matters less for prestige than for pattern: a clinic that only does this sees the unusual presentations often enough to recognise them, and has no reason to steer you toward whichever procedure it happens to own.

The full range available here:

• Microsclerotherapy · a very fine needle for spider veins and surface threads.
• Sclerotherapy · a liquid agent that seals small to medium veins from inside.
• Foam sclerotherapy · foam holds contact with the wall of a larger vein than liquid can.
• Endovenous laser ablation · a fibre closes a failed trunk vein with heat, through one puncture.
• Radiofrequency ablation · the same job, with radiofrequency energy rather than laser light.
• Cyanoacrylate closure · a medical adhesive seals the vein without heat, so the ring of anaesthetic along the vein is not needed.
• Ambulatory phlebectomy · bulging branches removed through punctures too small to stitch.

None of them is a treatment for every leg. The duplex ultrasound scan shows which vein has failed, in which direction the blood is falling and how large it is, and that is what picks the technique. Every one of them is done under local anaesthetic, with no general anaesthetic and no hospital stay, and every one carries some risk (bruising, temporary pigmentation along the treated vein, and less commonly inflammation of the vein) which is discussed with you in person before anything is decided.

Why there is no single best treatment

It is the most common question I am asked, and the honest answer is that the question has no single answer.

I thought I would need two visits, but it was completed in one. He scanned my veins and then performed the procedure. · Renée De Beer Saab, Google review

The techniques are not competing products where one is better than another. They treat different problems. A laser fibre is the wrong tool for a spider vein, and an injection will not hold a large trunk vein that is under pressure from above.

What decides it is the duplex ultrasound scan. It shows which veins have failed, in which direction the blood is falling, and how large the vein is. The scan chooses the technique. Nobody can choose it from a photograph, and neither can you.

Can tablets like Daflon cure varicose veins?

No, and this is worth being direct about because so many patients arrive already taking them.

Daflon 500 and similar venoactive tablets contain a micronised flavonoid fraction, usually diosmin with hesperidin. There is reasonable evidence that they reduce the symptoms of chronic venous disease: the heaviness, the aching, the evening swelling, the night cramps. Many patients genuinely feel better on them, and they have a place, particularly before treatment or where treatment is not yet indicated.

What they do not do is close a vein. A varicose vein is a mechanical problem, a valve that no longer seals, and no tablet repairs a valve. If the vein is still there when you stop, it is because the tablet was never treating the vein. They treat how the leg feels, not what the leg has.

The same applies to creams and to the sprays sold online. On that last point I am blunt with patients, because I see the results: nothing applied to the skin reaches a vein several millimetres beneath it.

What the stages mean, and what "stage 4" is

Doctors grade venous disease on a scale that runs from no visible sign at all to an open ulcer. In plain terms:

• Spider veins only · surface threads, no bulging vein. Often symptomatic despite looking minor.
• Visible varicose veins · the rope-like veins most people picture.
• Swelling · the ankle fills by evening and the sock leaves a mark.
• Skin changes, which is what people mean by stage 4 · brown discolouration above the ankle, dry or itchy eczema, and skin that begins to feel hard and tight. This is the stage most often dismissed as cosmetic ageing. It is not. It is the skin being damaged by pressure that has been there for years.
• Healed or open ulceration · the end of the same process.

Skin changes are a reason to be assessed sooner rather than a reason to give up. The underlying vein is usually still treatable with the same endovenous techniques, alongside compression and skin care, and closing the source is what stops the progression. Left alone, this stage does not stay still.

What is a doctor who specialises in veins called?

A phlebologist. Phlebology is the branch of medicine dealing with veins and venous disease. In practice many are also vascular surgeons, which matters because it means the same doctor can offer both the non-surgical techniques and the surgical ones, and has no reason to push you toward whichever they happen to do.

That is the situation here: general surgery and phlebology, working on leg veins and nothing else since 2010, at the Advanced Vein Clinic in Beirut and at Clemenceau Medical Center.

What is the fastest way to get rid of them?

The treatment itself is fast. An injection session is twenty to thirty minutes and you walk out. A trunk vein closed by laser is under an hour, once, under local anaesthetic.

What is not instant is the disappearance. A treated vein is closed immediately but is then reabsorbed by the body over the following weeks, and spider veins in particular fade over about four weeks rather than vanishing on the table. Anyone promising an immediate cosmetic result is describing something other than how veins heal.

What every technique has in common

No general anaesthetic, no hospital stay, and you walk out of the clinic. Expect mild bruising over the treated veins for one to two weeks, and a compression stocking for a short period afterwards. Every procedure carries some risk (bruising, temporary pigmentation along the treated vein, and less commonly inflammation of the vein) and those are discussed with you in person before anything is decided.