Patient guide
Advised varicose veins surgery? Laser and glue closure are non-surgical options to know first
Told you need varicose veins surgery (stripping and ligation)? Learn how laser and glue close the vein through a needle entry with no groin cut, what the CLASS trial found, and how to get a second opinion.
Advantages of laser and glue at a glance
- No groin cutLaser and glue use a needle entry
- 1% vs 7%Complications, laser vs surgery (CLASS)
- 83% vs 84%Main vein closed at 6 weeks
- Local numbingInstead of general anaesthesia
- Day careWalk in, walk out
- Back in daysUsual routine soon after
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Short videos on the same topic, in plain language.
What varicose veins surgery involves
Surgical treatment, called high ligation and stripping, ties off the vein at the groin and pulls out the faulty great saphenous vein through small cuts. It is normally done under general or spinal anaesthesia, and bruising and a longer recovery are common.
Laser, radiofrequency and glue do the same job differently. A thin catheter is passed into the vein under ultrasound guidance and the vein is sealed shut from the inside. There is no cut in the groin and no stitches [1, 2].
Surgery, laser and foam compared in a trial
The CLASS trial randomised 798 people with symptomatic varicose veins to foam sclerotherapy, endovenous laser ablation or surgery. Quality of life was generally similar across the groups, apart from slightly worse disease-specific quality of life after foam than after surgery [3].
| Surgery | Foam | Laser | |
|---|---|---|---|
| Procedural complications | 7% | 6% | 1% [3] |
| Main vein closed at 6 weeks | 84% | 55% | 83% [3] |
| Quality of life at 6 months | Similar | Slightly worse | Similar [3] |
| Disease-specific quality of life at 5 years | Better than foam | Lowest of the three | Better than foam [4] |
Brittenden et al., N Engl J Med 2014, 798 patients [3].
What this means for you
In the trial, laser closed the main vein as well as surgery, with fewer procedural complications [3], and it was the most likely to be cost-effective in the UK health system [5]. Your scan decides what suits you, and surgery may be considered when a vein is not suitable for a catheter:
- Very large or tortuous veins that cannot be treated by a catheter.
- Cases where laser or glue has been tried and failed.
- Veins that are best removed by phlebectomy, a small-cut removal of surface branches.
- Your preference, after hearing all the options.
Glue is a third route
Medical glue (VenaSeal) closes the vein with an adhesive instead of heat. It needs no numbing injections along the leg and often no compression stockings. It is a newer option used in selected patients. Our guide to glue versus laser covers it in detail.
Recovery and cost
Laser and glue are day-care procedures and most people return to routine within days. Surgery needs more recovery. Our varicose veins cost guide shows the Clinic Seven estimates for laser and glue, one leg or both, by room type, and has an estimate tool. Cashless treatment can be arranged, and eligibility is confirmed after a policy check.
Frequently asked questions
- Is varicose vein surgery necessary?
- Often not. Laser, radiofrequency and glue close the leaking vein through a needle entry, and UK guidance recommends heat-based closure as the first choice for a leaking trunk vein [1]. Surgery is reserved for veins that are not suitable.
- Is laser better than varicose veins surgery?
- In the CLASS trial the main vein was closed equally often (83% vs 84%) and quality of life was similar, but laser had fewer procedural complications, 1% against 7% [3].
- Is varicose veins surgery painful?
- It is done under general or spinal anaesthesia, so you feel nothing during it, but bruising and soreness for some days to weeks afterwards are common. Laser and glue are done with local numbing and recovery is usually quicker.
- How much does varicose veins surgery cost in Hyderabad?
- Prices vary between hospitals. At Clinic Seven the laser and glue estimates are on our varicose veins cost guide, by room type, one leg or both.
- Can varicose veins come back after treatment?
- New varicose veins can develop after any treatment because the tendency is partly inherited. Follow-up scans catch them early.
References
- National Institute for Health and Care Excellence. Varicose veins: diagnosis and management (CG168). Read the source
- NHS. Varicose veins: treatment. Read the source
- Brittenden J, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014;371(13):1218-1227. Read the source
- Brittenden J, et al. Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins. N Engl J Med. 2019;381(10):912-922. Read the source
- Tassie E, et al. Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial. Br J Surg. 2014. Read the source
Want to discuss your options?
Speak with the Clinic Seven team.