Varicose Vein Surgery

6 Questions to Ask Before Varicose Vein Surgery

Varicose vein surgery

When you see a doctor about varicose vein surgery, the treatment you’re offered often comes down to your doctor’s skill and preference for different techniques, and may not always align to your exact wants and needs as a patient. In this review, we share six questions to ask before varicose vein surgery to ensure you are fully educated.

Because we reference them throughout this review, we’ll start by summarizing the most common varicose vein treatment methods.

Foam Sclerotherapy: foam sclerotherapy is a minimally invasive treatment that involves the injection of a chemical solution called a sclerosant. The solution has a foamy consistency that fills the vein, displacing blood while the sclerosant irritates the vein walls, effectively closing off the vein.

Thermal Vein Ablation: thermal ablation is a minimally invasive treatment uses laser or radiofrequency energy to apply heat to the inside of the vein. This is done with catheter-based medical devices that are designed specifically for the veins. Intense heat causes the vein to collapse and seal shut.

VenaSeal Vein Glue: a specialized bio-safe, permanent glue is applied to the inside of the vein using minimally invasive devices and techniques. The vein is then compressed by pressing on the leg until the glue hardens and seals the vein shut.

Vein Stripping Surgery: vein stripping surgery is done by making incisions at the two ends of the vein and then threading a wire device (the “vein stripper”) through the vein from one incision to the other. The surgeon then pulls the wire out, bringing the vein out with it.

Vein Specialist Dr. Michael Lalezarian in Los Angeles, California

Vein Specialist

Dr. Michael Lalezarian

Vein problems? We can help you get your legs back. Dr. Michael Lalezarian is a double-board certified Vascular Interventional Radiologist specializing in minimally invasive vein treatments. He is a committed partner in the battle against the devastating consequences of venous insufficiency.
5-Star Varithena treatment in Los Angeles

“I was referred to Dr. Lalezarian from my orthopedic surgeon for varicose vein treatment options. From the second I walked into the office, I was at ease and felt very welcomed from Kimberly and the staff. Upon meeting the doctor, he was so kind and fully explained my options after the initial ultrasound on both legs. I decided to go with the sclerotherapy and am so happy that I did. The procedures were quick and virtually painless but the results are life changing for me. The pain suffered for so many years and countless sleepless nights are a thing of the past.”

Vickie W, March 2022

(1) Will this varicose vein surgery address all of my vein problems?

Varicose veins come in many shapes and sizes. Some are narrow and linear, others are wide and tortuous, and some can even appear as bubbles or ripples along the surface of the leg. Not every type of vein surgery is suitable for every type of varicose vein. Catheter-based vein surgeries like thermal vein ablation and VenaSeal vein glue are best-suited for long, straight vein segments where the catheter can be easily guided along the length of the vein. The same is true for vein stripping surgery. For more tortuous veins, foam sclerotherapy often does a better job of treating the entire vein because the foam injection is able to fill the corners and crevices of the twisting anatomy. Varicose veins are often sustained by accessory vessels, which are short segments of veins that connect the major veins together into a network. Foam sclerotherapy is also effective in treating these short accessory vessel segments that cannot be treated with thermal ablation or VenaSeal.
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Big tortuous varicose veins in need of vein surgery

(2) Is this treatment going to be painful?

There are several ways to treat a varicose vein. Some are more painful than others. Thermal ablation, for example, works by applying intense heat to the inside of the vein. Although steps are taken to numb the area and limit pain with local tumescent anesthesia, recipients of this therapy sometimes comment on the pain or discomfort that they experience during treatment. Veins tripping surgery also requires anesthesia, but with vein stripping, patients are given general anesthesia or spinal anesthesia to put the patient to sleep or to completely numb the leg prior to operating. While this eliminates pain during the procedure, recovery from the surgery can be quite painful. VenaSeal and foam sclerotherapy, on the other hand, are non-thermal treatments with a much lower risk of pain or discomfort during the procedure.

(3) How long does this treatment take?

Most vein procedures are finished in less than an hour, but certain types of vein treatment can take significantly longer than others. VenaSeal in particular is somewhat notorious for taking longer than other minimally invasive therapies because the glue requires the vein specialist to press down on the vein while the glue dries. This has to be done in short segments along the length of the vein, one segment at a time to ensure an effective seal. Vein stripping surgery can also require more time from the patient to ensure a healthy post-operative recovery and to allow the anesthesia to wear off. Other treatments, including thermal ablation and foam sclerotherapy are relatively quick, usually taking 30 minutes or less from start to finish.

(4) How long does varicose vein surgery recovery take?

With modern medical technology, most recipients of vein treatment return to their normal activities on the same day, immediately after the procedure. Patients are often advised to limit strenuous physical activity for a few days to ensure that the vein fully seals shut and that everything heals properly, but this is a very minor inconvenience for most. The one exception is vein stripping surgery, which can require longer recovery time due to the more invasive nature of the procedure. The incisions need time to heal, as does any trauma to the leg that’s caused by pulling out the vein, taking upwards of 2 to 4 weeks for a complete recovery.
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Vein surgery with foam sclerotherapy
Foam sclerotherapy treating multiple branching veins simultaneously.

(5) Are there side effects?

Significant complications of vein treatment are extremely rare, but short-term side effects are quite common. For minimally invasive treatments like thermal ablation, foam sclerotherapy, and VenaSeal, mild pain and inflammation at the puncture site and temporary skin discoloration are the most common side effects. Bleeding, bruising, rashing, and pain along the length of the treated vein are also possible with certain treatments. Thermal ablation introduces the unique risks of burning and nerve damage from the application of heat, and nerve damage is also possible with vein stripping surgery, but again, these compilations are relatively uncommon. These side effects are by no means comprehensive, and you should discuss all of the risks with your physician to make sure that you’re comfortable with the treatment that you receive.

(6) How long does it last?

Vein treatment isn’t always permanent. A minority of patients can see their varicose veins reopen years after a vein procedure. According to recent clinical research, around 50% of patients that receive minimally invasive vein treatments have a treated vein reopen or have new varicose veins develop within 5 years of their first treatment. This varies slightly from treatment to treatment, with thermal ablation (42%) seeing the most favorable outcome and foam sclerotherapy (53%) seeing the least favorable outcome amongst minimally invasive options. If you have more questions about varicose vein treatments or if you would like a second opinion on your current treatment plan, give us a call at ProVascularMD. We’ll help you work through your options and ensure that you find the most effective vein treatment for you.
Vein Treatment in Los Angeles
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More Resources
Stages of venous insufficiency

Stages of Venous Insufficiency

Learn about the stages of venous insufficiency, from spider veins to venous leg ulcers.
Venous leg ulcer treatment

Venous Leg Ulcer Treatment

Learn how minimally invasive vein treatments can help accelerate healing.
Los Angeles Vascular Specialist Dr. Michael Lalezarian

Vascular Specialist in Los Angeles

Learn more about Los Angeles Vascular Specialist Dr. Michael Lalezarian.

References [1] Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, Stijnen T, Neumann MH, Nijsten T. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013 Sep;58(3):727-734.e1. Epub 2013 Jun 13. [2] Coleridge Smith, P. (2009). Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology, 24(6), 260–269. [3] Chen CH, Chiu CS, Yang CH. Ultrasound-guided foam sclerotherapy for treating incompetent great saphenous veins–results of 5 years of analysis and morphologic evolvement study. Dermatologic Surg., June;38(6):851. Epub 2012 Apr 27. [4] Wrona, M., Jöckel, K. H., Pannier, F., Bock, E., Hoffmann, B., & Rabe, E. (2015). Association of Venous Disorders with Leg Symptoms: Results from the Bonn Vein Study 1. European Journal of Vascular and Endovascular Surgery, 50(3), 360–367. [5] Brittenden, J., Cooper, D., Dimitrova, M., Scotland, G., Cotton, S. C., Elders, A., … Campbell, M. K. (2019). Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins. New England Journal of Medicine, 381(10), 912–922.

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