Why Varicose Veins Shouldn’t Be Ignored

Varicose veins are one of the most common vascular conditions in the United States, affecting an estimated 35% of adults at some point in their lives. These enlarged, twisted veins — most often visible in the legs — are more than a cosmetic concern. Left untreated, varicose veins can lead to chronic pain, skin changes, swelling, and in some cases, serious complications like blood clots or venous ulcers.

The good news? Treatment has changed dramatically over the past decade. Modern minimally invasive procedures have largely replaced traditional vein stripping surgery, offering patients faster recovery, better outcomes, and the ability to return to daily life within days rather than weeks.

In this guide, Fabio Komlos, MD — a board-certified interventional radiologist in Mountain View, CA — breaks down the most effective varicose vein treatment options available in 2026 and what you should know before choosing a path forward.

Understanding Varicose Veins: Causes and Symptoms

Varicose veins develop when the one-way valves inside your veins weaken or fail. Normally, these valves keep blood flowing upward toward the heart. When they malfunction, blood pools in the vein, causing it to swell, bulge, and become visible beneath the skin.

Several factors increase your risk of developing varicose veins:

  • Age: Valve wear and tear increases over time, with risk rising significantly after age 50
  • Family history: Genetics play a major role — if your parents had varicose veins, your risk is higher
  • Prolonged standing or sitting: Jobs that require long periods in one position can impair circulation
  • Pregnancy: Increased blood volume and hormonal changes can weaken vein walls
  • Obesity: Excess weight puts additional pressure on leg veins

Common symptoms include aching or heavy-feeling legs, visible blue or purple twisted veins, swelling in the lower legs, itching around the affected veins, skin discoloration near the ankles, and muscle cramping — especially at night.

If you’re experiencing any of these symptoms, it’s important to have a vascular evaluation. Early treatment can prevent progression and improve your quality of life significantly.

Endovenous Laser Treatment (EVLT)

Endovenous laser treatment, commonly known as EVLT, is one of the most widely used and clinically proven treatments for varicose veins. It has become the gold standard for treating the underlying cause of most varicose veins — a condition called venous reflux in the great saphenous vein.

How EVLT Works

During an EVLT procedure, your interventional radiologist inserts a thin laser fiber into the affected vein through a tiny incision — typically near the knee. Using ultrasound guidance for precision, the fiber is positioned inside the vein and activated. The laser energy heats the vein wall, causing it to collapse and seal shut. Over time, your body naturally absorbs the treated vein, and blood reroutes through healthier veins.

What to Expect

  • Duration: 45–60 minutes
  • Anesthesia: Local anesthesia only — no general anesthesia required
  • Recovery: Most patients return to normal activities within 1–2 days
  • Success rate: Clinical studies show a 93–98% closure rate at 5 years
  • Setting: Performed in-office as an outpatient procedure

EVLT is particularly effective for larger varicose veins caused by saphenous vein reflux. It’s covered by most insurance plans when medically necessary.

Radiofrequency Ablation (RFA)

Radiofrequency ablation works on a similar principle to EVLT but uses radiofrequency energy instead of laser energy to heat and close the affected vein. Many patients and physicians prefer RFA for its controlled, consistent heating mechanism.

How RFA Works

A catheter is inserted into the diseased vein under ultrasound guidance. The catheter tip delivers radiofrequency energy in measured segments, heating the vein wall to a precise temperature. This causes the collagen in the vein wall to contract and the vein to close. Like EVLT, the sealed vein is eventually absorbed by the body.

Key Advantages

  • Less post-procedure discomfort compared to EVLT in some clinical comparisons
  • Precise temperature control reduces the risk of surrounding tissue damage
  • Similar success rates to EVLT — above 90% at 5 years
  • Same-day recovery with return to normal activities in 1–2 days

Your interventional radiologist will recommend EVLT or RFA based on your specific vein anatomy, the size and location of the affected veins, and your individual health profile.

Sclerotherapy

Sclerotherapy is a versatile treatment used for both spider veins and smaller varicose veins. It’s been performed for decades and remains one of the most effective options for veins that are too small for thermal ablation procedures like EVLT or RFA.

How Sclerotherapy Works

During sclerotherapy, a specialized solution — called a sclerosant — is injected directly into the affected vein using a very fine needle. The solution irritates the vein lining, causing it to swell, stick together, and eventually scar closed. Blood flow is redirected to healthier veins, and the treated vein fades over the following weeks.

For larger veins, foam sclerotherapy may be used. In this variation, the sclerosant is mixed with air to create a foam that has greater contact with the vein wall, making it more effective for bigger vessels.

What to Expect

  • Duration: 15–30 minutes per session
  • Sessions needed: Most patients require 2–4 sessions for optimal results
  • Recovery: No downtime — you can resume normal activities immediately
  • Results: Treated veins typically fade within 3–6 weeks
  • Compression: You’ll wear compression stockings for 1–2 weeks after treatment

Sclerotherapy is often used in combination with EVLT or RFA as part of a comprehensive vein treatment plan — addressing the smaller branch veins after the main source of reflux has been treated.

Ambulatory Phlebectomy

For large, bulging surface varicose veins that are too big for sclerotherapy but don’t require thermal ablation, ambulatory phlebectomy offers an effective solution.

How Ambulatory Phlebectomy Works

This procedure involves making tiny micro-incisions — typically 2–3 millimeters — along the path of the varicose vein. Through these small openings, the vein is gently removed in segments using a specialized hook instrument. The incisions are so small they don’t require stitches and heal with minimal scarring.

Key Benefits

  • Immediate visible improvement — the bulging vein is physically removed
  • Local anesthesia only — performed in-office
  • Minimal scarring — micro-incisions heal nearly invisibly
  • Often combined with EVLT or RFA for comprehensive treatment

How to Choose the Right Treatment

The best varicose vein treatment depends on several factors unique to each patient. During your consultation, your interventional radiologist will evaluate:

  • Vein size and location: Larger truncal veins typically require EVLT or RFA, while smaller veins respond well to sclerotherapy
  • Severity of symptoms: Patients with significant pain, swelling, or skin changes may need a combination approach
  • Underlying reflux: A duplex ultrasound will identify whether there’s an underlying valve problem that needs to be addressed first
  • Your health history: Previous treatments, medications, and other health conditions all factor into the treatment plan
  • Your goals: Whether you’re primarily concerned about symptoms, appearance, or both

Many patients benefit from a combination of treatments — for example, EVLT to address the source of reflux, followed by sclerotherapy to treat remaining spider veins and small branches.

Insurance Coverage and Cost Considerations

When varicose veins cause symptoms such as pain, swelling, skin changes, or bleeding, treatment is considered medically necessary and is typically covered by most insurance plans, including Medicare.

Your insurance may require a trial of conservative treatment first — usually wearing compression stockings for a specified period — before approving a procedure. Your interventional radiologist’s office can help navigate the prior authorization process and verify your coverage before treatment begins.

Cosmetic-only treatments, such as sclerotherapy for spider veins without associated symptoms, are generally not covered by insurance.

Why Choose an Interventional Radiologist for Vein Care

Interventional radiologists are uniquely qualified to treat varicose veins. Their extensive training in image-guided procedures — using ultrasound and fluoroscopy — allows for exceptional precision during treatment. This training background means:

  • Superior visualization: Real-time ultrasound guidance ensures accurate catheter placement
  • Minimally invasive expertise: IR physicians specialize in treatments that avoid open surgery
  • Comprehensive approach: They can diagnose and treat the full spectrum of venous disease, from spider veins to complex venous insufficiency

Take the Next Step

If you’re living with varicose veins — whether they’re causing daily discomfort or you’re concerned about their appearance — modern treatment options can help. Most procedures take less than an hour, require no general anesthesia, and allow you to return to your normal routine within days.

Fabio Komlos, MD provides comprehensive vein evaluations and personalized treatment plans at his Mountain View, CA practice. Every consultation begins with a thorough duplex ultrasound to understand the full picture before recommending a path forward.

Schedule your vein consultation today: Call (650) 404-8445 or visit fabiokomlosmd.com to learn more.