Varicose Veins Laser Treatment (EVLT)
Heavy, aching legs and ropey blue veins are a circulation problem, not a cosmetic one — and they do not resolve on their own. Our vascular surgeons treat them with endovenous laser ablation: a 45-minute daycare procedure through a pinhole, no stripping, no long scar. Walk out the same day, back to desk work in 2–3 days, with cashless insurance and a coordinator who stays with you throughout.
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What is Varicose Veins?
Varicose veins are veins in the legs that have become permanently widened, twisted and visible under the skin. They are the outward sign of a mechanical failure inside the vein — and understanding that failure explains almost everything about the condition.
Blood in the legs has to travel upwards, against gravity, back to the heart. It does this with help from the calf muscles, which squeeze the deep veins with every step, and from a series of one-way valves inside the veins that stop blood falling back down between squeezes. When those valves fail, blood pools in the vein instead of moving on. The pressure inside rises, the vein wall stretches, and over months and years it becomes the bulging, rope-like cord you can see. Doctors call the underlying problem venous reflux or chronic venous insufficiency.
This is why varicose veins are progressive. The pooled blood raises pressure, the raised pressure damages more valves, and more damaged valves mean more pooling. Left alone, the condition tends to move in one direction — from tired, aching legs, to ankle swelling, to skin discolouration around the ankle, to eczema, and eventually in some patients to a venous ulcer that is slow and difficult to heal.
It is also why compression stockings, though genuinely useful, are not a cure. They support the leg from the outside and relieve symptoms while they are worn, but they do not repair a failed valve. The only treatments that address the cause are the ones that shut the refluxing vein down so blood is rerouted through healthy veins instead.
The good news is that closing a diseased superficial vein is safe. Over ninety per cent of the leg's venous return happens through the deep veins; the great and small saphenous veins that usually cause varicose veins are superficial, and the leg copes perfectly well without them. Modern endovenous laser ablation exploits this: instead of surgically stripping the vein out through incisions, a thin laser fibre is passed inside it through a needle puncture and the vein is sealed shut from within.
One caution worth stating plainly. Varicose veins are frequently dismissed as a cosmetic complaint, by patients and sometimes by doctors. Visible veins with no symptoms may indeed need nothing more than monitoring. But aching, heaviness, night cramps, swelling or any skin change at the ankle are signs of established venous hypertension, and those deserve a duplex scan rather than reassurance.
Treatment information
| Condition | Varicose Veins / Chronic Venous Insufficiency |
|---|---|
| Procedure | Endovenous Laser Ablation (EVLT / EVLA) |
| Duration | 45 to 90 minutes |
| Treated by | Vascular Surgeon |
| Anaesthesia | Local tumescent anaesthesia, sometimes with sedation |
| Success rate | 95–98% |
| Recovery time | 2 to 5 days |
| Hospital stay | Daycare — same-day discharge in most cases |
Signs you may need Varicose Veins treatment
- Visible blue, green or purple veins that bulge and look twisted or rope-like
- Heaviness or aching in the legs, typically worse by evening and after long standing
- Swelling around the ankles that improves overnight
- Night cramps in the calf, and restless legs at bedtime
- Itching or burning over the vein
- Brown or rusty discolouration of the skin around the ankle
- Dry, scaly, eczema-like patches over the lower leg
- Hardened, tight skin above the ankle (lipodermatosclerosis)
- A slow-healing wound or open ulcer near the ankle in advanced disease
- Bleeding from a vein that has been knocked or scratched
What causes it?
- Failure of the one-way valves inside the leg veins (venous reflux)
- Weakness of the vein wall, which is often inherited
- Sustained high pressure in the leg veins from long hours of standing or sitting
- Pregnancy — increased blood volume plus hormonal softening of the vein walls
- Obesity, which raises abdominal pressure and loads the leg veins
- A previous deep vein thrombosis that damaged the deep venous system
- Pelvic vein compression or obstruction blocking the outflow from the leg
Who is more likely to be affected
- A parent or sibling with varicose veins — family history is the single strongest factor
- Occupations involving long hours on your feet: surgeons, teachers, retail staff, security personnel, hospitality workers
- Desk jobs with long uninterrupted sitting and little walking
- Female sex, particularly after multiple pregnancies
- Increasing age, as vein walls and valves lose elasticity
- Being overweight or obese
- Prolonged immobility, including long-haul travel
- A past history of DVT or leg injury
When to see a doctor immediately
- Legs that ache, throb or feel heavy by the end of most days
- Ankle swelling that has started to appear regularly
- Any change in the colour or texture of the skin around the ankle
- A vein that has become red, hard and tender — this may be superficial thrombophlebitis
- Bleeding from a varicose vein, which needs urgent attention
- A wound near the ankle that is not healing within two weeks
- Sudden swelling of one whole leg with pain — this needs same-day assessment to rule out DVT
How it is diagnosed
Clinical examination while standing
Varicose veins fill and become obvious under gravity, so the examination is done with you standing rather than lying down. The surgeon maps which veins are involved, looks for swelling and inspects the skin around the ankle for the changes that indicate long-standing venous hypertension.
Venous duplex ultrasound
The single most important test, and the one that decides the treatment. This painless scan watches blood flow in real time and measures how long blood falls backwards when the calf is squeezed and released. It identifies exactly which veins are refluxing, how far the reflux extends, the diameter of the vein, and — critically — whether the deep veins are healthy. No treatment plan should be made without it.
CEAP classification
An international grading system from C0 to C6 that records how advanced the disease is, from no visible signs through visible veins, swelling, skin changes and finally healed or active ulceration. It standardises the record and is usually what insurers look for when assessing a claim.
Assessment for deep vein involvement
If the duplex suggests old clot or obstruction in the deep system, further imaging may be needed. This matters because the superficial veins should not be closed if they are acting as an essential bypass around a blocked deep vein.
Pelvic imaging in selected cases
Advised when varicose veins appear in unusual locations, recur after previous surgery, or are accompanied by pelvic symptoms — to look for compression or reflux in the pelvic veins feeding the leg.
How the options compare
| Feature | Open Surgery (Ligation & Stripping) | Endovenous Laser Ablation |
|---|---|---|
| Access | Incisions in the groin and lower leg | A single needle puncture |
| Anaesthesia | Spinal or general | Local tumescent, often awake |
| Procedure time | 60–120 minutes | 45–90 minutes |
| Scarring | Visible groin scar | No scar of significance |
| Bruising | Extensive along the thigh | Mild and localised |
| Pain after surgery | Moderate to significant | Mild |
| Hospital stay | Usually overnight | Daycare, same-day discharge |
| Walking | Same day, but uncomfortable | Within an hour of the procedure |
| Return to work | 2–3 weeks | 2–5 days |
| Recurrence rate | Higher, from neovascularisation at the groin | Lower |
Types of treatment
Conservative management
Graduated compression stockings
Class II medical compression relieves aching and swelling by supporting the vein from outside and helping the calf pump work. Genuinely effective at controlling symptoms — but it manages the condition rather than curing it, and only works on the days you actually wear them.
Calf pump activation and leg elevation
Walking, ankle-pumping exercises and elevating the legs above heart level for twenty minutes twice a day all reduce venous pressure. Most useful for patients with early disease and for anyone whose job involves standing still.
Venoactive medication
Micronised flavonoid preparations reduce oedema and the sensation of heaviness in some patients. Supportive only; they do not close a refluxing vein.
Weight reduction
Lowering abdominal pressure meaningfully reduces the load on the leg veins, and improves the durability of whatever treatment follows.
Endovenous (minimally invasive) treatment
Endovenous laser ablation (EVLT / EVLA)
The workhorse procedure. Under ultrasound guidance a laser fibre is threaded up inside the diseased vein through a needle puncture below the knee, dilute anaesthetic is infiltrated around the vein, and the fibre is withdrawn slowly while delivering laser energy that seals the vein shut along its length. Closure rates are 95–98% at one year.
Radiofrequency ablation (RFA)
The same principle using controlled heat from a radiofrequency catheter rather than laser light. Outcomes are comparable to laser; some patients report slightly less post-procedure bruising and tightness.
Medical glue closure (cyanoacrylate)
A medical adhesive seals the vein without heat, which means no tumescent anaesthesia injections along the thigh and no compression stockings afterwards in many cases. More expensive, and not always covered by insurance.
Ultrasound-guided foam sclerotherapy
A foamed sclerosant is injected under ultrasound control to close tributary veins and smaller trunks. Often used alongside ablation rather than instead of it, and useful for recurrent veins after previous surgery.
Ambulatory phlebectomy
The bulging surface veins themselves are hooked out through 2–3 mm nicks that need no stitches. Usually combined with ablation in the same sitting, since closing the trunk alone does not always flatten large surface clusters.
Conventional surgery
Ligation and stripping
The traditional operation: the saphenous vein is tied off at the groin and physically pulled out. Still occasionally the right choice — for very large or unusually tortuous veins that a catheter cannot navigate — but for most patients endovenous ablation has replaced it, with less pain and a far faster return to work.
Venous ulcer care
Where an ulcer has already formed, treatment combines closing the underlying reflux with compression bandaging and structured wound care. Correcting the reflux is what stops the ulcer recurring after it heals.
What happens, step by step
- 1
Consultation and duplex scan
45–60 minutes- A vascular surgeon examines both legs while you are standing
- A venous duplex ultrasound maps exactly which veins are refluxing
- Deep vein health is confirmed before any plan is made
- You are shown your own scan and told which veins will be treated and why
- 2
Pre-operative preparation
30–45 minutes- Routine blood tests and ECG are reviewed
- The veins are re-marked on the skin under ultrasound with you standing
- Consent is taken and the leg is cleaned and draped
- Compression stockings are fitted in advance so they are ready at discharge
- 3
The ablation
45–90 minutes- A needle puncture is made over the vein, usually near the knee or calf
- The laser fibre is advanced up the vein under ultrasound guidance
- Dilute local anaesthetic is infiltrated around the vein — this numbs it and protects surrounding tissue
- Laser energy is delivered as the fibre is withdrawn, sealing the vein from the inside
- Surface veins are treated in the same sitting with phlebectomy or foam if needed
- There is no groin incision and no stitching
- 4
Compression and early walking
30–60 minutes- The leg is wrapped and the compression stocking is applied
- You are asked to walk within the first hour — early walking reduces clot risk
- A completion ultrasound may confirm the vein has closed
- 5
Discharge
Same day- Most patients go home within a few hours of the procedure
- Painkillers and, where indicated, a short course of blood thinner are prescribed
- Stocking-wearing schedule and walking targets are explained in writing
- Your free cab drops you home and a follow-up duplex is scheduled
How to prepare
- Complete the pre-operative blood tests, ECG and duplex scan as advised
- Tell your surgeon about blood thinners, hormone therapy or oral contraceptives
- Buy or collect the prescribed class of compression stockings before the procedure day
- Shave the leg the evening before if asked to, and avoid applying any cream or oil on the day
- Eat a light meal unless sedation is planned, in which case fast as instructed
- Wear loose trousers and comfortable walking shoes to the hospital
- Arrange for an adult attendant to accompany you home
Why patients choose this procedure
Treats the cause, not just the appearance
Closing the refluxing vein removes the source of the raised pressure. The aching, heaviness and swelling improve because the underlying circulation problem has been corrected.
Pinhole access, no stripping
The vein is sealed from the inside through a needle puncture. There is no groin incision, no scar worth mentioning and none of the extensive bruising that follows stripping.
Awake, daycare procedure
Most ablations are done under local tumescent anaesthesia. You are admitted and discharged the same day, and you walk out of the hospital yourself.
Back to routine in days
Desk work is usually resumed within 2 to 5 days, against 2 to 3 weeks after conventional stripping.
High and durable closure rates
95–98% of treated veins remain closed at one year, and recurrence from groin neovascularisation — a known problem after stripping — is much less common.
Prevents progression
Treating reflux early stops the march towards skin discolouration, eczema and venous ulceration, all of which are far harder to reverse than to prevent.
Possible risks and side effects
Bruising and tightness along the treated vein
Expected rather than unusual. A firm, tender cord along the inner thigh for two to four weeks is the vein scarring down as intended, not a complication.
Skin numbness or tingling
Small sensory nerves run alongside the saphenous veins, particularly below the knee. A patch of numbness on the inner calf or ankle occurs in a minority of patients and usually recovers over weeks to months.
Superficial thrombophlebitis
A treated tributary can become red, hard and tender. It is uncomfortable but settles with anti-inflammatories, compression and continued walking.
Deep vein thrombosis
Uncommon after endovenous ablation, and reduced further by early walking, compression and — in higher-risk patients — a short course of blood thinner. Sudden swelling or pain in the calf should be reported immediately.
Skin burn or pigmentation
Rare with proper tumescent infiltration, which acts as a heat sink around the vein. Brown staining over a treated surface vein can occur and usually fades over several months.
Recurrence or residual veins
New veins can develop over the years, particularly if the family predisposition is strong or the risk factors continue. Residual surface veins sometimes need a top-up session of foam sclerotherapy, which is planned at follow-up rather than treated as a failure.
What recovery looks like
Recovery after endovenous laser ablation is defined by one instruction more than any other: walk. Movement is not something to be eased back into here — it is part of the treatment, because the calf pump is what keeps blood moving through the deep veins while the treated vein scars down.
Day 0: you walk within an hour of the procedure and go home the same day. Expect a tight, heavy feeling in the leg rather than sharp pain. Take the prescribed painkillers on schedule rather than waiting for discomfort.
Days 1 to 7: wear the compression stocking exactly as instructed — typically continuously for the first 48 hours, then through the day for two to four weeks. Aim for a 20–30 minute walk two or three times a day. Most patients with desk jobs return to work between day 2 and day 5. Bruising along the thigh appears now and looks worse than it feels.
Weeks 2 to 6: the treated vein becomes a firm, tender cord along its course. This is normal and gradually softens. Avoid heavy lifting, long-haul flights, hot tubs and steam rooms during this period. Swimming and cycling are usually fine after two weeks.
Weeks 6 to 12: the cord settles, bruising clears and the cosmetic result becomes apparent. A follow-up duplex confirms the vein has stayed closed. Any residual surface veins are assessed at this point and treated with foam if you want them dealt with.
Contact your care coordinator immediately if you develop sudden calf swelling or pain, redness spreading up the leg, fever, breathlessness or chest pain.
What to eat and what to avoid
Recommended
- High-fibre foods — oats, whole grains, dals and pulses — to avoid straining, which raises venous pressure
- Citrus fruit, berries, guava and amla for flavonoids and vitamin C, which support vein wall integrity
- Green leafy vegetables and beetroot
- Nuts and seeds for vitamin E
- 3 to 4 litres of water through the day
- Lean protein to support tissue healing after the procedure
Best avoided
- Excess salt and packaged food, which worsen leg swelling
- Deep-fried and heavily processed food
- Refined sugar and maida products
- Alcohol, which dilates veins and worsens the heaviness
- Smoking, which damages blood vessel walls and slows healing
- Prolonged standing or sitting without moving the ankles
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Varicose Veins treatment cost
₹60,000 – ₹1,50,000
The range depends on whether one leg or both are treated, how many veins need ablating, whether sclerotherapy or phlebectomy is added for surface veins, the technology used (laser, radiofrequency or medical glue), your city, the hospital and your room category. Varicose vein surgery is covered by most health insurance policies once the condition is documented as symptomatic — our insurance desk checks your eligibility and files the cashless request before admission, at no charge.
Inside the care journey
Varicose Veins — your questions answered
Visible veins with no symptoms may need nothing more than monitoring and compression. But aching, heaviness, night cramps, ankle swelling or any brown discolouration of the skin means venous pressure is already raised, and that is a medical problem. Untreated, it progresses towards skin damage and eventually venous ulceration, which is far harder to treat than the veins were.