Varicose veins treatment

Varicose veins are treated today with modern, minimally invasive methods whenever the case allows: steam ablation (the STEAM method), foam sclerotherapy, laser therapy, venous cryotherapy, endoscopic treatment or the Alpha method. Veins are no longer pulled out as in classic surgery — their calibre is reduced or the vein is closed completely (obliterated), and the body gradually resorbs it. The right method is chosen after a vascular evaluation with Doppler ultrasound, based on the type of veins affected, the symptoms and the stage of the venous disease.

Dr. Marius Fodor, senior vascular surgeon in Cluj-Napoca, Romania, recommends and performs these treatments with a focus on the aesthetic result, safety and a fast recovery.

Varicose vein treatment at a glance

• Available methods: steam ablation (STEAM), foam sclerotherapy, laser therapy, venous cryotherapy, endoscopic treatment, the Alpha method
• Type of procedures: mostly minimally invasive, without classic surgery and without vein stripping
• Duration: usually a few tens of minutes per session
• Hospitalisation: usually not needed; many procedures are outpatient
• Pain: minimal discomfort; no significant post-operative pain with modern methods
• Recovery: normal activities can be resumed quickly, depending on the method
• First step: a vascular surgery consultation with Doppler ultrasound

What are varicose veins and why do they appear?

Veins are the blood vessels that carry blood from all parts of the body back to the heart. Vein walls contain little muscle, so the return of blood against gravity is ensured by one-way valves. When these valves stop working properly — for various reasons — blood flows in both directions and pools, the veins dilate, and their walls weaken and lose elasticity. This is how varicose veins appear: stretched, wide and visible, most often on the thighs, the calf muscles and behind the knees.

Factors that favour the appearance of varicose veins

• standing for long periods of time
• prolonged and intense muscular effort
• excessive heat and humidity
• obesity and hormonal changes (including pregnancy)
• injuries to the lower limbs
• genetic predisposition

More about the disease mechanism, symptoms and stages on the Varicose veins page.

What symptoms do varicose veins cause?

Besides the visible veins and skin colour changes, varicose veins produce a series of clinical manifestations:

• heaviness and tiredness in the legs, worse in the evening
• itching (pruritus) along the veins
• swollen ankles and calves (oedema)
• night cramps and tingling (paraesthesia)
• burning sensations
• exercise intolerance
• restless legs syndrome

Symptoms are usually milder in the early stages of the disease, become moderate in the intermediate ones and worsen after years of progression. This is why treatment is best started early, at the first symptoms.

What happens if varicose veins are not treated?

Left untreated, varicose veins tend to grow larger and are associated with a series of complications, the most severe of which are:

• Deep vein thrombosis — blood clots forming in the deep veins. It can trigger pulmonary embolism, a life-threatening complication. Varicose veins are among the risk factors for deep vein thrombosis.
• Chronic venous insufficiency — the return of blood through the veins is impaired long-term; the main causes are varicose veins and chronic venous thrombosis.
• Venous (varicose) ulcers — varicose veins and venous insufficiency weaken the skin’s cell layer; when damaged skin lets bacteria and air into the tissue, open wounds or crusts appear, with the surrounding area red and swollen, healing very slowly.
• Rupture of a varicose cluster — can cause massive bleeding and requires emergency care.

Many patients seek treatment for purely aesthetic reasons — the desire to eliminate the unsightly appearance of their legs. That is a perfectly valid reason, with an important bonus: treating varicose disease early also eliminates the risk of developing the complications above.

How is the right method chosen?

The first step is a vascular surgery consultation, which includes a Doppler ultrasound. It shows how the valves of the deep and superficial veins work, where reflux (backwards flow) exists, and whether the visible veins are only a superficial problem or the effect of a wider venous insufficiency. Based on this venous “map”, the doctor recommends the right method or combination of methods — according to the complexity of the symptoms, the size and course of the affected veins, and the stage of the disease.

Modern methods are the least painful ones: in many cases the procedures are performed without hospitalisation, take only a few tens of minutes, and the discomfort felt is minimal. The absence of post-operative pain and visible scars is a major advantage over classic surgery.

What modern methods exist for treating varicose veins?

Steam ablation (the STEAM method)

The affected vein is closed with pulses of water vapour, through a fine 1.2 mm catheter, under local anaesthesia and ultrasound guidance. Used since 2006 and awarded first place in 2010 by the European Venous Forum as the best and most original varicose vein treatment method, steam ablation is extremely versatile: the vapour reaches even the winding portions of the veins, where rigid catheters cannot go. The procedure takes 30–40 minutes, and the patient goes home the same day.

Foam sclerotherapy

A sclerosing agent in foam form is injected with a fine needle directly into the affected vein, producing a controlled inflammatory reaction that closes the vein; it fades within a few weeks and is resorbed by the body. Indicated for telangiectasias (“spider veins”), reticular veins, isolated, recurrent or below-knee varicose veins — no scalpel, no anaesthesia, no hospitalisation.

Laser therapy

Intense pulsed light beams heat the blood and the vein wall, and the vein closes through fibrosis. The simple variant treats superficial veins (in 3–5 sessions), while the endovenous variant also treats large veins — with an efficiency of about 94% demonstrated in studies. Daily activities are resumed the same day.

Venous cryotherapy

Varicose veins are removed through controlled freezing and thawing, usually with liquid nitrogen at about −85 °C, through a single small incision. It is an alternative to classic surgical removal, with fewer complication risks and cosmetic scars of only 2–3 mm.

Endoscopic treatment

The problem veins are visualised with a miniature video camera introduced through a small incision, then ligated, closed and removed completely. It is the method of choice for large varicose veins and for cases with advanced venous disease — trophic disorders or venous ulcers.

The Alpha method

Combines foam sclerotherapy with continuous ultrasound guidance: the foam is injected through a special catheter, while the doctor watches the injection point, the amount and distribution of the agent and the vein’s immediate reaction on screen. The extra precision allows the treatment of deep veins, inaccessible to direct visual control.

Which is the best treatment for varicose veins?

The best treatment for varicose veins is the one suited to the specific case — there is no single method for all patients. As a general guide:

• steam ablation (STEAM) — preferred by specialists and patients in most cases, for its versatility, aesthetic and functional result and fast recovery
• foam sclerotherapy / the Alpha method — the first option for small veins, reticular veins and telangiectasias
• endovenous laser — an effective alternative for straight venous trunks
• endoscopic treatment / cryotherapy — for large veins or advanced cases, with trophic disorders or venous ulcers

The final choice depends on the vascular evaluation, the size and course of the veins, the symptoms, the stage of the disease and the patient’s goal — including the aesthetic one.

Frequently asked questions

Can varicose veins be treated without classic surgery?

Yes. In many cases varicose veins can be treated with minimally invasive methods — STEAM, foam sclerotherapy, laser, cryotherapy or the Alpha method — without vein stripping and without hospitalisation. The closed vein is naturally resorbed by the body.

Does varicose vein treatment hurt?

Modern methods involve little discomfort: most procedures are done under local anaesthesia or with no anaesthesia at all, and post-operative pain is usually minimal or absent. The level of discomfort depends on the method, the patient’s sensitivity and the complexity of the case.

How long does a procedure take?

Most minimally invasive procedures take a few tens of minutes — steam ablation about 30–40 minutes, a laser session between 15 and 45 minutes, a sclerotherapy session a few minutes. Patients usually go home the same day.

Will there be scars after treatment?

Modern methods leave no visible scars or only millimetre-sized marks: sclerotherapy and the Alpha method use only needle pricks, STEAM and laser a fine puncture, and cryotherapy a 2–3 mm incision. The final appearance depends on the method and on each patient’s healing.

Can varicose veins come back after treatment?

A risk of recurrence exists with any method, but it is low with modern procedures performed correctly — after steam ablation, for example, the probability of recurrence is very low. Venous disease can produce new veins over time, which is why the pre-treatment ultrasound evaluation and follow-up checks matter.

What happens at the first consultation?

The doctor examines your legs clinically, performs the Doppler ultrasound to evaluate the deep and superficial venous circulation, establishes the diagnosis and stage of the disease, and discusses the treatment options suited to your case — including realistic aesthetic expectations and the next steps.