If you still picture varicose vein treatment as painful “vein stripping” surgery with weeks of downtime, you’re not alone — but that image is more than a decade out of date.
Varicose veins affect roughly 35% of adults in the United States, and the treatment landscape has changed dramatically. In 2026, the standard of care is minimally invasive, performed in an outpatient setting, and lets most patients walk out the door and return to normal activity within a day or two.
As a board-certified interventional radiologist based in Mountain View, California, I spend every week helping patients understand their options — and reassuring them that modern vein care is nothing like the procedures their parents may have gone through. This guide walks you through what varicose veins actually are, which treatments are available today, how to decide which one is right for you, and what recovery really looks like.
What Are Varicose Veins, Really?
Varicose veins are swollen, twisted veins — usually in the legs — that become visible at or just under the skin. They develop when the tiny one-way valves inside your veins stop working properly. Normally, those valves keep blood flowing upward toward the heart. When they fail, blood pools in the vein, stretching it out and causing the characteristic bulging, ropey appearance.
While many people think of varicose veins as a cosmetic issue, they’re often a symptom of an underlying condition called chronic venous insufficiency (CVI). Left untreated, CVI can lead to:
- Aching, heaviness, or throbbing in the legs
- Swelling around the ankles, especially at the end of the day
- Skin discoloration (reddish-brown staining near the ankles)
- Itching or burning over the affected veins
- Leg cramps at night
- In more advanced cases, skin ulcers that don’t heal
The takeaway: if your veins are more than a cosmetic concern — if they hurt, swell, or interfere with your day — they deserve a medical evaluation, not just concealer.
When Should You See a Vein Specialist?
You should consider evaluation by an interventional radiologist or vein specialist if you notice any of the following:
- Bulging, rope-like veins in your legs
- Legs that feel heavy, tired, or achy, especially after standing
- Swelling in one or both legs that gets worse as the day goes on
- Darkening or hardening of the skin near the ankles
- Open sores (venous ulcers) near the ankle that won’t heal
- Sudden leg swelling, warmth, or pain — this can indicate a deep vein thrombosis (DVT) and is a medical emergency
A proper evaluation typically includes a physical exam and a venous duplex ultrasound, a painless imaging test that maps how blood is flowing through your leg veins and identifies which valves are leaking.
Modern Varicose Vein Treatments: The 2026 Landscape
Today’s vein treatments are outpatient, image-guided, and designed to minimize recovery time. Here are the main options you’ll encounter — and how they actually work.
1. Endovenous Laser Treatment (EVLT)
What it is: EVLT uses targeted laser energy to seal the diseased vein from the inside. Using ultrasound guidance, a thin fiber is inserted through a tiny puncture in the skin, threaded into the faulty vein, and activated to heat and close it. Your body then naturally reroutes blood flow through healthy nearby veins.
Best for: Larger varicose veins caused by saphenous vein reflux — often the root cause of the bulging veins you can see on the surface.
What the procedure feels like: Local anesthesia is used to numb the area. Most patients describe mild pressure but very little pain. The procedure typically takes 30 to 60 minutes.
Recovery: You’ll walk out the same day. Most patients return to work and light activity within 24 to 48 hours. Vigorous exercise is usually restricted for about a week.
Effectiveness: Long-term closure rates for EVLT consistently sit at 95% or higher, making it one of the most reliable vein treatments available.
2. Radiofrequency Ablation (RFA)
What it is: RFA works on the same principle as EVLT — sealing the diseased vein from the inside — but uses radiofrequency energy (heat) instead of laser energy. A catheter is guided into the vein and slowly withdrawn, closing the vein as it goes.
Best for: Patients with saphenous vein reflux who may benefit from slightly lower post-procedure discomfort than EVLT.
What the procedure feels like: Like EVLT, RFA is performed under local anesthesia. Many patients report slightly less bruising and soreness compared to laser-based treatment.
Recovery: Same-day discharge. Most patients resume normal activity within 1 to 2 days.
Effectiveness: Closure rates are comparable to EVLT, with studies showing long-term success rates above 93%.
3. Sclerotherapy
What it is: Sclerotherapy involves injecting a medical solution (a “sclerosant”) directly into the vein. The solution irritates the vein wall, causing it to collapse and eventually be absorbed by the body. For deeper or larger veins, an ultrasound-guided foam sclerotherapy technique is often used.
Best for:
- Traditional sclerotherapy: Spider veins and small varicose veins
- Foam sclerotherapy: Medium-sized varicose veins or residual veins after EVLT/RFA
What the procedure feels like: A series of small, quick injections. Most patients describe the sensation as minor pinching or burning that resolves within seconds.
Recovery: Essentially none. You can walk out and resume normal activity immediately. Compression stockings are typically worn for a few days to a couple of weeks.
Effectiveness: Excellent for targeting smaller cosmetic veins and for cleaning up after larger treatments.
4. Ambulatory Phlebectomy
What it is: A minor in-office procedure in which bulging surface veins are gently removed through tiny micro-incisions — so small they usually don’t require stitches.
Best for: Large, ropey, bulging varicose veins close to the skin that aren’t the best candidates for ablation or sclerotherapy alone. Often combined with EVLT or RFA in a single visit.
Recovery: Same-day discharge, return to normal activity within 1 to 2 days, minimal scarring.
How Do You Know Which Treatment Is Right for You?
The short answer: you don’t — and you shouldn’t have to.
The right treatment depends on:
- Vein anatomy and size (only visible on ultrasound)
- Which valves are leaking (saphenous vs. branch veins)
- Severity of symptoms (cosmetic vs. aching, swelling, or skin changes)
- Your overall health and activity level
- Whether insurance will cover the procedure (many varicose vein treatments are covered when medically necessary)
A thorough venous evaluation — history, physical exam, and duplex ultrasound — is the foundation of every treatment plan we build. In many cases, the best plan combines two techniques: for example, EVLT or RFA to close the underlying feeder vein, followed by sclerotherapy or phlebectomy to clean up the surface veins.
What Recovery Really Looks Like
One of the most common questions I hear is: “How long will I be out of commission?”
Here’s the honest answer for modern minimally invasive vein treatment:
- The day of the procedure: You’ll walk out of the office. You may wear a compression stocking and be asked to avoid strenuous activity. Most patients go home, have dinner, and resume light activity the same evening.
- The next 24 to 48 hours: Most people return to work and normal daily activities. You may notice some tenderness, mild bruising, or a “pulling” sensation along the treated vein.
- The first week: Light walking is encouraged — it actually speeds recovery. Avoid heavy lifting, hot baths, saunas, and vigorous exercise.
- Weeks 2–4: Most activity restrictions lift. Many patients notice their symptoms — heaviness, aching, swelling — significantly improve even before the cosmetic changes are visible.
- 1–3 months: The full cosmetic result becomes visible as the treated vein is absorbed by the body and blood reroutes through healthy vessels.
Compare that to traditional vein stripping — which could mean weeks of downtime, general anesthesia, and noticeable scars — and you can see why minimally invasive care has become the standard.
Will Insurance Cover My Treatment?
In most cases, yes — when the treatment is medically necessary. Insurance typically covers varicose vein procedures if you have documented symptoms (pain, swelling, skin changes, ulcers, bleeding) and have tried conservative measures like compression stockings first.
Purely cosmetic treatment of spider veins is usually not covered, but the evaluation to determine medical necessity is. At our practice, we walk every patient through their coverage before proceeding so there are no surprises.
Why Choose an Interventional Radiologist for Vein Care?
Interventional radiologists are physicians who specialize in image-guided, minimally invasive procedures. Vein disease is part of our core training — and because we use ultrasound and fluoroscopic imaging in real time, we can see exactly what’s happening inside the vein throughout the entire procedure.
That precision matters. It means smaller incisions, more accurate targeting, fewer complications, and better long-term outcomes.
As a board-certified interventional radiologist, I’ve dedicated my practice to helping patients in Mountain View and the surrounding Bay Area get back on their feet — literally — without the downtime of traditional surgery.
Frequently Asked Questions
Are varicose veins dangerous?
Varicose veins themselves are rarely life-threatening, but they can be a sign of chronic venous insufficiency, which can lead to skin ulcers, bleeding, and, in rare cases, superficial thrombophlebitis. Sudden swelling, warmth, or pain — especially in one leg — can signal a deep vein thrombosis (DVT) and should be evaluated immediately.
Does varicose vein treatment hurt?
Modern treatments are performed under local anesthesia. Most patients describe the procedure as mildly uncomfortable — similar to a dental cleaning — and are surprised by how quickly it’s over.
How long does varicose vein treatment take?
Most procedures take between 30 and 60 minutes. You’ll typically be at the office for 1 to 2 hours total, including prep and recovery.
Will my varicose veins come back after treatment?
Treated veins do not “reopen” — they’re sealed closed and absorbed by the body. However, new varicose veins can develop in other parts of the leg over time, especially if you have genetic risk factors. Annual follow-ups help catch new issues early.
Can I exercise after varicose vein treatment?
Light walking is encouraged immediately. Most patients resume full exercise routines within 1 to 2 weeks. Your specific timeline will depend on the procedure performed.
How quickly will my symptoms improve?
Many patients notice reduced heaviness, aching, and swelling within days of treatment — often before the cosmetic changes become visible.
Is vein treatment covered by insurance?
Most medically necessary vein treatments are covered by insurance. Our team will verify your coverage and explain your benefits before any procedure.
Ready to Find Out If You’re a Candidate?
If varicose veins are slowing you down — whether with aching, swelling, or visible bulging — you have more options today than ever before. The first step is a proper evaluation so you can understand what’s actually happening in your legs and build a treatment plan that fits your goals.
Call Fabio Komlos, MD — Board-Certified Interventional Radiologist
📞 (650) 404-8445
🌐 fabiokomlosmd.com
📍 Mountain View, CA
We’ll answer your questions, review your insurance coverage, and help you take the first step toward healthier, more comfortable legs.
Fabio Komlos, MD is a board-certified interventional radiologist specializing in minimally invasive vascular and vein treatments. This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional regarding your specific condition.
