What Is the Best Varicose Veins Treatment in 2026?

The Best Varicose Veins Treatment in 2026

For most people with symptomatic varicose veins caused by reflux in the great or small saphenous vein, the preferred treatment in 2026 is generally duplex-ultrasound-guided endovenous ablation.

This includes:

• Endovenous Laser Ablation, also called EVLA or EVLT
• Radiofrequency Ablation, or RFA
• Endovenous Microwave Ablation
• Cyanoacrylate Glue Closure in selected patients

Current clinical guidelines generally favour endovenous ablation over traditional vein stripping when the patient’s anatomy is suitable. However, there is no single treatment that is best for every patient. The correct option depends on the location of the damaged vein, the pattern of reflux, vein size, symptoms, previous treatments and the patient’s medical history.

A Doppler Scan Is the First Step

The best treatment cannot be selected simply by looking at the visible veins.

A venous duplex or Doppler ultrasound scan is required to:

• Identify the vein causing backward blood flow
• Measure the extent of venous reflux
• Examine the deep and superficial veins
• Detect previous blood clots or obstruction
• Plan the safest treatment route

NICE recommends duplex ultrasound to confirm varicose veins, determine the extent of truncal reflux and plan treatment for both primary and recurrent varicose veins.

1. Endovenous Laser Ablation

Endovenous Laser Ablation, or EVLA, is one of the most proven minimally invasive techniques used in the treatment of varicose veins. During the procedure, a laser fibre is placed inside the damaged vein under ultrasound guidance. Laser energy is delivered to close the diseased vein, allowing blood to flow through healthier veins.

EVLA is performed through a small needle puncture, usually under local anaesthesia. It is a minimally invasive alternative to traditional surgical vein stripping.

Benefits of EVLA

• No large surgical incisions
• Can usually be performed under local anaesthesia
• Suitable for significant superficial vein reflux
• Can often be performed as a day-care procedure
• Early walking is usually encouraged
• Proven clinical effectiveness and experience

EVLA may be appropriate for patients with significant reflux in the great saphenous vein, small saphenous vein or accessory saphenous veins.

2. Radiofrequency Ablation

Radiofrequency Ablation is another major endovenous technique used for treating varicose veins. Instead of laser energy, RFA uses controlled radiofrequency heat to seal the diseased vein. A catheter is inserted into the vein under ultrasound guidance, and the vein is treated in sections.

Both RFA and EVLA belong to the category of endothermal ablation procedures. NICE recommends endothermal ablation as a first treatment option for varicose veins with truncal reflux when it is clinically suitable.

Benefits of RFA

• Minimally invasive procedure
• Small puncture instead of a large incision
• Usually performed under local anaesthesia
• Same-day discharge may be possible
• Most patients can return to daily activities quickly
• Effective for appropriately selected refluxing veins

RFA may be selected depending on the size, anatomical location and characteristics of the diseased vein.

3. Endovenous Microwave Ablation

Endovenous Microwave Ablation is a newer thermal technique used for treating varicose veins. A small microwave ablation catheter is inserted into the abnormal vein under ultrasound guidance. Microwave energy then produces controlled heat that closes the diseased vein.

Emerging research suggests that endovenous microwave ablation may provide short-term outcomes comparable to established techniques such as EVLA and RFA. However, long-term evidence and inclusion in major clinical guidelines are not yet as extensive as they are for laser and radiofrequency ablation.

Therefore, microwave ablation should be considered for appropriately selected patients and performed by specialists experienced in image-guided venous procedures.

Possible Advantages of Microwave Ablation

• Ultrasound-guided and minimally invasive
• Controlled thermal treatment
• Performed through a small entry point
• Day-care treatment may be possible
• Promising option for selected vein patterns

4. Cyanoacrylate Glue Therapy

Cyanoacrylate Glue Therapy is a non-thermal method of closing diseased veins. A medical adhesive is delivered into the vein through a small catheter. The adhesive seals the vein, allowing blood to flow through healthier veins.

Because Glue Therapy does not use heat, it may reduce the need for multiple injections of tumescent anaesthesia commonly required during thermal ablation. A five-year randomised study reported that cyanoacrylate closure was non-inferior to RFA for great saphenous vein closure.

Glue Therapy May Be Considered When

• A non-thermal treatment is preferred
• The vein location is less suitable for thermal treatment
• The patient wishes to avoid multiple anaesthetic injections
• The specialist determines that the vein anatomy is favourable

Glue Therapy is not necessarily superior to laser ablation or RFA. Factors such as treatment cost, vein anatomy, inflammatory response, allergies and the patient’s medical history must be considered.

5. Ultrasound-Guided Foam Sclerotherapy

During foam sclerotherapy, a sclerosant medicine is converted into foam and injected into the diseased vein under ultrasound guidance. The medicine irritates the vein lining, causing the vein to collapse and gradually close.

Foam Sclerotherapy May Be Used For

• Smaller varicose veins
• Twisted veins that cannot be accessed with a catheter
• Remaining veins after endovenous ablation
• Recurrent varicose veins
• Patients who may not be suitable for thermal ablation

When significant truncal reflux is present, clinical guidelines generally favour endothermal ablation over foam sclerotherapy when the patient’s anatomy is suitable.