Varicose veins affect more than half of all people over age 50, mostly women. They occur when faulty valves in the legs prevent blood from flowing properly to the heart. Instead, the blood pools in the legs and increases pressure in the veins, causing them to enlarge. Severe varicose veins can cause

  • pain
  • throbbing
  • swelling
  • venous stasis ulcers (skin sores)
  • fatigue
  • thrombophlebitis (inflammation in a vein caused by a blood clot)
  • changes in the skin such as discoloration, dryness and scabbing

In some cases, varicose veins can limit the ability to perform everyday activities.

A German research team recently compared two common treatments used to remove or destroy severe varicose veins: high ligation and saphenous vein stripping (HLS), a conventional surgical procedure, and endovenous laser ablation (EVLA), a minimally invasive procedure. The study, published online in the journal Archives of Dermatology, sought to compare the length of time patients went without a recurrence of varicose veins, which is often caused by neovascularization—the abnormal growth of new blood vessels.

Researchers concluded that surgery and laser treatment are equally safe and effective. After two years, rates of new varicose vein growth were similar between both HLS and EVLA, and the veins that grew back or reopened didn't cause symptoms or affect quality of life among most patients.

High ligation and stripping

HLS involves surgically removing, or "stripping," varicose veins. The surgeon cuts and ties off (ligation) the top of the vein through a small incision, inserts a flexible tube into the vein and then pulls it out along with the vein (stripping).

The procedure is usually done on an outpatient basis, so you'll likely be able to go home the same day. To aid recovery, your doctor will have you walk for several minutes each hour. You'll wear bandages for three to five days to reduce swelling and bleeding and possibly for several weeks after. It may take several weeks before you can return to your normal routine.

HLS complications include nerve injury, bruising, hematomas (pooled clotted or partially clotted blood), thrombophlebitis and neovascularization as well as risks associated with open surgery such as bleeding and infection.

Endovenous laser ablation

During EVLA, the doctor inserts a thin tube (catheter) into your vein through a small puncture. Intense heat from a laser travels through the catheter and seals the vein, blocking blood flow.

You'll usually be able to walk and go home on the same day and return to regular activities the next. The vein will shrink and disappear over time. In the study, EVLA patients were significantly more satisfied with their cosmetic results than HLS patients were.

EVLA has a low rate of complications, but they can still occur. They include temporary nerve damage, bruising, hematomas and thrombophlebitis, but the minimally invasive procedure doesn't carry the risks associated with open surgery.

Another effective endovenous treatment is radiofrequency ablation, which wasn't used in the study. Radiofrequency ablation uses a high-frequency alternating current instead of laser energy to seal the vein.

Doctor's Viewpoint

Jennifer Heller, M.D., Asst. Professor, Dept. of Surgery Director, Johns Hopkins Vein Center Johns Hopkins Bayview Medical Center

The findings show that both procedures are good options for severe varicose veins if lifestyle changes and medical treatments don't relieve your symptoms or you simply want to improve appearance. However, open surgery can result in significant complications and downtime. Percutaneous endovenous therapy was developed to eliminate the drawbacks of open surgery.

It's important that you weigh the risks and benefits of each procedure with your doctor to find the treatment strategy that's right for you, since outcomes vary among individuals.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 18 Jul 2013

Last Modified: 16 Mar 2015