“Doctor, can’t this be treated with medicines alone?”
This is a question I hear often, particularly from patients above 60 who have lived with prominent leg veins for years.
Some have had very little pain. They have taken medicines on and off, struggled to wear compression stockings consistently, and postponed further assessment. By the time they visit, the skin around the ankle may already be dark, itchy or hardened. Others seek treatment only when a wound develops and refuses to heal.
Their hesitation is understandable: “If these veins might come back after treatment, is it worth doing anything now?”
It deserves an honest answer.
Little pain does not always mean a healthy leg
Varicose veins develop when vein valves do not work properly, allowing blood to flow backwards and increasing pressure in the veins.
This pressure can gradually affect the surrounding skin. Darkening, eczema, persistent swelling and skin hardening are more than cosmetic changes—even if the leg does not hurt much.
Not every patient will develop an ulcer. But waiting for one before seeking care can mean allowing existing skin damage to progress.
Can medicines alone solve the problem?
Medicines may help reduce aching, heaviness or swelling. Walking, leg elevation and appropriately prescribed compression stockings can also help manage symptoms.
However, tablets do not repair faulty vein valves or eliminate the underlying backward flow of blood.
If stockings are uncomfortable or difficult to put on, tell your doctor. Their fit, compression level and suitability can be reviewed.
For some patients, supportive measures and observation are appropriate. For others—particularly those with symptoms or skin changes—treating the underlying venous problem may offer greater benefit.
Treating the source matters
Good treatment begins with a detailed venous Doppler ultrasound.
The aim is to identify where the abnormal flow starts and which veins contribute to the problem. These may include the main superficial veins, their branches and, in selected cases, faulty perforator veins connecting the superficial and deep systems.
The treatment plan should address the sources of abnormal flow, rather than focusing only on visible bulging veins. This does not mean every abnormal vein needs treatment; the plan should be tailored to the individual.
Many suitable patients can be treated using minimally invasive procedures without open surgery.
What if the veins come back?
Here is the distinction I explain to patients:
Recurrence is possible. The myth is that this makes treatment pointless.
Appropriate treatment can provide lasting relief. Careful planning helps address the relevant sources of reflux, while follow-up helps identify residual or new problems early.
Still, no treatment can guarantee that another vein will never become affected. New varicose veins may develop, or a treated vein may reopen. The likelihood and timing vary between patients.
Importantly, recurrence does not necessarily mean the original disease returns in its full severity.
A small recurrent vein that causes no significant symptoms or skin damage may only need observation or supportive care. Some recurrences needing treatment can be managed with a minor outpatient procedure, such as ultrasound-guided sclerotherapy.
Others require more detailed reassessment or additional treatment. We decide based on symptoms, skin health, Doppler findings, overall health and the patient’s preferences—not age alone.
The goal is a healthier leg
Treatment is about more than removing visible veins. It is about improving comfort, reducing abnormal venous pressure and supporting skin health and ulcer healing where relevant.
Existing skin changes may not disappear completely, and follow-up remains important.
Not everyone with visible veins needs a procedure. But skin darkening, persistent itching, hardening or a wound should not be ignored simply because there is little pain.
My message to patients is straightforward:
“We cannot promise that no vein will ever return. But we can assess the problem properly, treat what needs treatment, and manage future changes if they occur. The possibility of recurrence should not stop you from caring for the leg you have today.”
Don’t wait for an ulcer to take your vein health seriously.