Ghatkopar (East), Mumbai)
Home > Interventional radiology >Varicose Veins
Varicose Veins Treatment in Mumbai
Varicose veins enlarged, tortuous, dilated superficial veins visible beneath the skin surface are not merely a cosmetic problem. They are a manifestation of chronic venous insufficiency caused by incompetent venous valves that allow blood to pool and reflux in the leg veins rather than return efficiently to the heart. Left untreated, varicose veins progress through increasingly severe stages: from asymptomatic visible veins through aching, heaviness, skin changes, lipodermatosclerosis, and ultimately to venous leg ulceration a chronic, painful wound that affects quality of life profoundly and is difficult and expensive to heal.
At Shree Hospitals Ghatkopar East, our Interventional Radiology team treats varicose veins using modern, minimally invasive endovenous techniques - Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA) — that eliminate the diseased vein permanently under local anaesthesia, with patients walking within the hour and returning to work in 24–48 hours, without a surgical incision or general anaesthesia.
(24×7 Emergency Care)
(24×7 Emergency Care)
Our Approach
(24×7 Emergency Care)
Our approach in managing Varicose Veins
Effective varicose vein management at Shree Hospitals requires accurate duplex ultrasound mapping of venous reflux, a clear understanding of the patient's disease severity and symptoms, and the selection of the appropriate endovenous technique or combination of techniques that addresses the anatomical pattern of disease. Our five-step approach begins with thorough vascular assessment and ends with long-term compression and surveillance to prevent recurrence.
Step 1 — Duplex Ultrasound Mapping of Reflux
Varicose veins are the consequence of venous valve incompetence ,one-way valves in the great saphenous vein (GSV), small saphenous vein (SSV), and their tributaries fail to prevent retrograde blood flow (reflux) during standing. Duplex ultrasound is the essential diagnostic tool: it visualises the saphenous veins, measures vein diameter, demonstrates reflux with Valsalva manoeuvre or calf compression (reflux >0.5 seconds on duplex is clinically significant), identifies perforator vein incompetence, maps the saphenofemoral junction (SFJ) and saphenopopliteal junction (SPJ), and identifies deep venous system competence. At Shree Hospitals, duplex mapping is performed by our vascular technologist before every varicose vein intervention a veins treatment planned without prior duplex is a treatment planned without complete anatomical information and is more likely to fail or recur.
Step 2 — CEAP Classification and Treatment Stratification
Disease severity is classified using the CEAP system: C0 (no visible disease), C1 (telangiectases/spider veins), C2 (varicose veins), C3 (oedema), C4a (skin pigmentation/eczema), C4b (lipodermatosclerosis), C5 (healed ulcer), C6 (active venous ulcer). CEAP classification determines treatment urgency and guides the combination of interventions required: C2 disease with reflux requires endovenous ablation of the axial reflux source; C4b–C6 disease is urgent and requires both ablation of axial reflux and active wound care for venous ulcers; C1 telangiectases without saphenous reflux are treated with surface sclerotherapy after confirming that no underlying axial reflux is driving the spider veins. Symptoms — aching, heaviness, itching, restless legs, cramps , are independently documented and do not always correlate with visible disease severity.
Step 3 — Endovenous Thermal Ablation: EVLA or RFA
Endovenous thermal ablation — delivered by laser (EVLA) or radiofrequency (RFA) energy , is the current gold standard for treating great saphenous vein (GSV) and small saphenous vein (SSV) reflux, superseding the traditional surgical ligation and stripping procedure that required general anaesthesia, a hospital admission, and 2–4 weeks of recovery. Both techniques work by delivering controlled thermal energy to the venous endothelium, causing irreversible damage to the vessel wall, coagulative occlusion, and permanent fibrotic obliteration of the vein. EVLA at Shree Hospitals uses 1470nm diode laser energy (the most current wavelength, targeting water in the venous wall rather than haemoglobin , producing a cleaner, more uniform ablation and fewer side effects than earlier 810nm or 980nm systems). RFA uses the ClosureFast bipolar radiofrequency catheter, which heats 7cm venous segments sequentially to 120°C in 20-second cycles. Both procedures are performed under ultrasound guidance, through a catheter inserted via a 2mm skin puncture at knee level, under tumescent local anaesthesia (dilute lidocaine injected around the vein under ultrasound guidance) no general anaesthesia, no hospital admission, walking within the hour.
Step 4 — Foam Sclerotherapy and Tributary Phlebectomy
Following axial vein ablation, residual varicose tributaries, the visible superficial varicosities , are treated in the same session or at a scheduled second visit. Ultrasound-guided foam sclerotherapy (UGFS) injects a microfoam preparation of sodium tetradecyl sulphate (STS) or polidocanol into varicose tributaries under ultrasound visualisation , the foam displaces blood within the vein lumen and produces chemical endothelial damage and sclerosis. Foam sclerotherapy is particularly effective for tributaries that cannot be reached by tumescent infiltration, for perforator vein incompetence, and for small-diameter residual varicosities. Micro-phlebectomy (stab avulsions) removes large, tortuous, superficial varicosities through 2mm micro-incisions under tumescent local anaesthesia for patients who prefer immediate visible removal rather than the progressive resolution of sclerotherapy.
Step 5 — Compression Therapy and Recurrence Prevention
Compression hosiery , graduated below-knee compression stockings at class 2 (23–32 mmHg) , is worn for 2 weeks after endovenous ablation and then long-term in patients with C3–C6 disease to maintain venous haemodynamics, reduce post-procedure superficial thrombophlebitis risk, and prevent progression of chronic venous disease. Post-procedure duplex ultrasound at 3 months confirms treatment success: the ablated GSV or SSV should be fibrosed and non-compressible, with no residual reflux. New tributary varicosities or perforator incompetence identified at 3 months are treated with additional foam sclerotherapy. Long-term lifestyle advice , avoiding prolonged standing, maintaining a healthy weight, exercising the calf muscle pump, and wearing compression during air travel, reduces the risk of new varicose vein development from untreated minor tributaries.
How to identify Varicose veins?
Varicose veins are visible as enlarged, bulging, tortuous blue-green veins beneath the skin surface, most commonly on the inner calf, posterior calf, and thigh following the course of the great saphenous vein (medial leg from ankle to groin) or small saphenous vein (posterior calf from ankle to knee). They are most prominent on standing and diminish when the legs are elevated. In addition to the visible veins, chronic venous insufficiency produces a characteristic symptom complex: aching heaviness and fatigue in the legs typically worse after prolonged standing and improving with elevation; leg swelling (oedema) worst by evening and resolving overnight; pruritis (itching) over the varicose vein tributaries; cramps, particularly nocturnal; and restless legs an uncomfortable urge to move the legs that is worse when sitting or lying still.
As chronic venous insufficiency progresses without treatment, skin changes develop that signal advancing venous hypertension. Hyperpigmentation brownish discolouration around the ankle and lower leg results from haemosiderin deposition from extravasated red blood cells. Venous eczema produces itchy, weeping, erythematous skin over the lower leg. Lipodermatosclerosis fibrotic induration and hyperpigmentation of the lower leg skin and subcutaneous tissue represents advanced chronic venous damage that significantly restricts skin compliance and predisposes to venous ulceration. An acute flare of lipodermatosclerosis presents as hot, red, tender, indurated skin that mimics cellulitis and is frequently treated with antibiotics before the venous cause is recognised.
Urgency Indicators — When Varicose Vein Assessment Cannot Be Deferred:
- Active venous ulcer (C6 disease) an open wound on the medial gaiter region of the ankle that will not heal without treatment of the underlying venous reflux
- Superficial thrombophlebitis a painful, red, firm cord along a varicose vein caused by thrombosis within it; requires anticoagulation assessment if extending above the knee
- Sudden haemorrhage from a ruptured varicose vein particularly in thin-skinned elderly patients; apply direct pressure and attend emergency immediately
- Rapidly progressive lipodermatosclerosis
Important FAQs: Varicose veins
Are varicose veins purely cosmetic or do they cause health problems?
Varicose veins are often dismissed as cosmetic but this is a significant undercharacterisation of their clinical impact. Varicose veins are the visible manifestation of chronic venous insufficiency a failure of the venous pump to return blood efficiently from the legs to the heart. Without treatment, chronic venous insufficiency progresses predictably through increasingly severe CEAP stages: from visible varicose veins to oedema, skin pigmentation, venous eczema, lipodermatosclerosis, and eventually venous leg ulceration in 5–10% of untreated patients. Venous leg ulcers are painful, difficult to heal, expensive to dress, recurrent, and profoundly reduce quality of life. Varicose veins also cause daily symptoms aching, heaviness, cramps, restless legs that are often normalised for years. They also carry a small but measurable risk of superficial thrombophlebitis and, if the thrombus extends into the deep venous system, deep vein thrombosis. Treatment of varicose veins is not cosmetic surgery , it is preventive vascular medicine.
Is EVLA/RFA better than traditional surgical vein stripping?
Yes — multiple large randomised controlled trials including the REACTIV, EVOLVeS, and CLASS trials consistently demonstrate that EVLA and RFA achieve equivalent or superior vein occlusion rates compared with surgical stripping at 1, 2, and 5 years, with significantly less post-procedure pain and bruising, significantly shorter recovery time, no general anaesthesia requirement, no hospital admission, no surgical incision, and equivalent or lower recurrence rates at 5 years. The National Institute for Health and Care Excellence (NICE, UK) recommends EVLA, RFA, and foam sclerotherapy as first-line treatments for varicose veins, with surgical stripping reserved only for cases where endovenous techniques are anatomically unsuitable. Traditional vein stripping is no longer the standard of care in centres with endovenous capabilities , which Shree Hospitals provides.
Will my varicose veins come back after laser treatment?
The treated vein , once permanently obliterated by EVLA or RFA — does not recur at the ablated segment. Recurrence of varicose veins occurs from new reflux developing in previously normal vein segments , the neovascularisation (new vessel formation) that occurs at the old SFJ site in a proportion of patients (lower with endovenous ablation than with traditional surgery), and the unmasking of pre-existing minor reflux in untreated tributaries that becomes hemodynamically significant after the main reflux channel is eliminated. Long-term follow-up studies show 10–20% recurrence rates at 5 years with endovenous techniques , significantly lower than the 20–30% recurrence at 5 years after surgical stripping. Wearing compression stockings, maintaining body weight, exercising the calf muscle pump, and returning for assessment if new varicosities appear reduces the clinical impact of recurrence.
Can varicose veins be treated during pregnancy?
Varicose veins commonly appear or worsen during pregnancy due to progesterone-induced venous wall relaxation and increased blood volume causing venous dilation, combined with the gravid uterus compressing the iliac veins and increasing leg venous pressure. In the majority of cases, varicose veins that develop during pregnancy improve significantly within 3–6 months after delivery as these physiological changes reverse. For this reason, definitive treatment of varicose veins is generally deferred until at least 3–6 months after delivery and cessation of breastfeeding. During pregnancy, compression stockings are the recommended management , reducing symptom severity (aching, heaviness, oedema) without procedural risk to the fetus. Foam sclerotherapy and endovenous thermal ablation are contraindicated during pregnancy. Women whose varicose veins persist or worsen beyond 6 months post-delivery should seek specialist vein assessment and treatment.
What is the difference between varicose veins and spider veins?
Spider veins (telangiectases) the fine red, purple, or blue thread-like networks of dilated capillaries visible just beneath the skin surface are classified as C1 disease in the CEAP system. They are smaller and more superficial than varicose veins, do not protrude above the skin surface, and rarely cause significant symptoms beyond occasional localised aching. They are treated with surface sclerotherapy (fine needle injections of sclerosant without ultrasound guidance) rather than endovenous ablation. Varicose veins (C2 and above) are larger, protrude above the skin surface as palpable tortuous cords, and are caused by incompetent saphenous venous reflux that requires duplex assessment and endovenous ablation. When spider veins coexist with saphenous reflux, treating the spider veins before ablating the underlying reflux source leads to high recurrence rates — the primary reflux must be treated first.
Treatments for Varicose Veins at Shree Hospitals
Duplex Ultrasound Vein Mapping
Duplex ultrasound at Shree Hospitals provides complete anatomical mapping of the venous reflux pattern before any treatment is planned. GSV and SSV diameter, reflux duration (above 0.5 seconds is pathological), SFJ and SPJ competence, deep venous system patency, and perforator vein incompetence are systematically assessed with the patient standing. The duplex report is the essential planning document for every varicose vein intervention it identifies which vein is the primary reflux source, guides the choice between EVLA and RFA, determines the length of vein requiring ablation, and identifies additional tributary patterns requiring supplementary foam sclerotherapy or micro-phlebectomy. Duplex mapping also identifies the rare cases of varicose veins secondary to deep venous thrombosis or May-Thurner syndrome where treating the superficial varicosities without addressing the underlying deep venous obstruction would be inadequate.
Endovenous Laser Ablation (EVLA)
EVLA at Shree Hospitals uses 1470nm diode laser energy delivered through a thin optical fibre inserted via a 2mm skin puncture under duplex guidance. Tumescent local anaesthesia 250–500ml of dilute lidocaine solution injected around the vein under ultrasound guidance provides complete anaesthesia of the treatment zone and creates a thermal safety margin protecting surrounding tissues from heat spread. The laser fibre is withdrawn at a controlled rate of 1–2mm per second, delivering uniform thermal energy that permanently obliterates the GSV or SSV lumen over its entire length in a single continuous treatment. Total procedure time is 30–45 minutes per leg. No sutures, no general anaesthesia, walking immediately after. EVLA produces 95%+ GSV occlusion rates at 1 year with significantly lower rates of post-procedure bruising, pain, and nerve injury compared with earlier-wavelength laser systems.
Radiofrequency Ablation (RFA) — ClosureFast
RFA with the ClosureFast catheter is an alternative to EVLA that achieves identical efficacy using radiofrequency rather than laser energy. The ClosureFast catheter heats 7cm venous segments sequentially to 120°C with bipolar radiofrequency delivery, causing endothelial coagulation and vein wall shrinkage in 20-second treatment cycles. Advantages of RFA over EVLA include: even lower post-procedure pain and bruising scores in head-to-head comparisons, a slightly faster return-to-work time, and a shorter treatment session. Both EVLA and RFA are available at Shree Hospitals; the choice between them is made based on vein diameter, tortuosity, and patient preference after discussion with the interventional radiologist. For very large diameter or tortuous GSVs, EVLA with the 1470nm system may achieve more consistent circumferential heating.
Foam Sclerotherapy & Micro-Phlebectomy for Tributary Varicosities
After axial vein ablation, residual varicose tributaries the visible bulging clusters of varicosities on the calf and thigh are eliminated with ultrasound-guided foam sclerotherapy or micro-phlebectomy stab avulsions. Foam sclerotherapy injects a medically prepared foam of sodium tetradecyl sulphate under ultrasound guidance directly into the tributaries, causing chemical endothelial damage and permanent vein closure over 4–6 weeks. The foam is visible on ultrasound, confirming distribution within the target tributaries. Micro-phlebectomy removes larger, more superficial varicosities through 2mm stab incisions under tumescent local anaesthesia with a small hook instrument providing immediate visible clearance and a histological specimen. Surface sclerotherapy with fine needles treats residual spider veins (telangiectases, C1 disease) as a final cosmetic step. The complete varicose vein treatment at Shree Hospitals typically requires 1–2 sessions and is performed entirely without general anaesthesia.
Varicose Vein & Vascular Specialists in Mumbai
Now at Shree Hospitals
10+ years of experience
Dr. Swati Narurkar
Interventional Radiology
For Appointment/Query
1800-268-4000
Tele consultation/2nd Opinion
Schedule Consultation
News & Updates
Shree Hospitals Expands Paediatric Surgical Care With Latest Technology
Shree Hospitals Installs a Robotic-Assisted Surgical System for Better Patient Care
