About Vein Treatment Options
Four minimally invasive treatments are used for varicose veins at our centres: radiofrequency ablation, endovenous laser ablation, VenaSeal glue closure and ultrasound guided foam sclerotherapy. All are performed in our own office operating room under local anaesthetic.
Patients often want to know which is best. The honest answer is that there is no single best procedure — the appropriate treatment depends on your venous anatomy as shown on duplex ultrasound. This page sets out how the four differ and how the choice is made.
Comparing Vein Treatments: RFA, EVLA, VenaSeal and Foam Sclerotherapy
There is no single best vein procedure
Patients often arrive having read that one technique is the “gold standard” and another is outdated. That is not how the choice is made in practice.
All four treatments close a faulty vein so that blood redirects through healthy veins. They differ in how they close it, whether anaesthetic must be injected around the vein, which vein shapes they suit, and how they are funded. Your duplex ultrasound anatomy determines which is appropriate — which veins are refluxing, how deep and how tortuous they are, and what has been treated before.
Current international guidelines recommend endovenous techniques in preference to open surgery for most patients with symptomatic superficial reflux, without designating a single endovenous method as superior for everyone12.
Side-by-side comparison
| Radiofrequency ablation | EVLA (laser) | VenaSeal (glue) | Foam sclerotherapy | |
|---|---|---|---|---|
| How the vein is closed | Heat, from a radiofrequency catheter | Heat, from a laser fibre | Cyanoacrylate adhesive (medical glue) | A sclerosant foam that irritates the vein lining |
| Tumescent anaesthetic needed | Yes | Yes | No | No |
| Best suited to | Straight truncal reflux | Truncal reflux, including veins less suited to RFA | Selected truncal reflux, where avoiding tumescent injections matters | Tortuous veins, tributaries, residual and recurrent veins |
| Typical procedure time | 20 to 40 minutes | 20 to 40 minutes | 20 to 40 minutes | 15 to 30 minutes |
| Where performed | Office, local anaesthetic | Office, local anaesthetic | Office, local anaesthetic | Office |
| Compression afterwards | Bandage 24 hours, then stocking | Bandage 24 hours, then stocking | Bandage 24 hours, then stocking | Stocking for several days |
| Main limitations | Not suited to very tortuous veins | Slightly more bruising reported in the first week | Generally not funded by medical schemes | Pigmentation and matting; often needs more than one session |
| Medical scheme funding | Verified individually | Verified individually | Usually payable by the patient | Verified individually |
A general guide. Individual recommendations depend on your duplex findings, previous treatment and clinical circumstances. * Individual results may vary.
Radiofrequency ablation
A catheter is passed inside the faulty vein and heats a segment of the vein wall to a controlled temperature, sealing it as the catheter is withdrawn. Tumescent anaesthetic is injected around the vein, both to numb it and to protect surrounding nerves from the heat.
Where it fits. Our most commonly used treatment for straight truncal reflux in the great or small saphenous vein, and the technique with the largest body of long-term evidence behind it.
Limitations. The catheter needs a reasonably straight path, so very tortuous veins are better treated another way. More about radiofrequency ablation.
EVLA laser ablation
The same principle using a laser fibre. Laser delivers energy at a higher peak temperature at the fibre tip; radiofrequency heats a segment to a controlled temperature.
Where it fits. Randomised comparisons and a meta-analysis of 29 studies found broadly similar closure rates between laser and radiofrequency34. We use laser where vein size, depth or configuration makes it the better choice.
Limitations. Some studies report slightly more bruising in the first week, though this narrows with modern fibres34. More about EVLA.
VenaSeal glue closure
A cyanoacrylate adhesive seals the vein instead of heat. With no heat, no tumescent anaesthetic is needed — a single needle puncture per vein rather than injections along its length, and no risk of thermal nerve injury.
Where it fits. Selected truncal reflux, particularly where avoiding the tumescent injections matters to the patient.
Limitations. Generally not funded by South African medical schemes, which is a practical consideration when weighing it against the thermal techniques. More about VenaSeal.
Foam sclerotherapy
A sclerosant is mixed into a foam and injected under ultrasound guidance. The foam displaces blood and contacts the vein lining directly, causing it to close.
Where it fits. Tortuous veins a catheter cannot navigate, tributaries and branch veins, and veins that have returned after previous surgery. Most often used alongside ablation of the underlying trunk rather than alone.
Limitations. Pigmentation is reported in roughly 10 to 30% of patients and matting in about 15 to 24%5. More than one session is often needed, and a known right-to-left cardiac shunt is an important consideration. More about foam sclerotherapy.
What they all have in common
Whichever technique is used, the essentials are the same at our centres:
- A duplex ultrasound scan of both legs before anything is planned.
- Performed in our own office operating room under local anaesthetic.
- No hospital admission, no general anaesthetic, no anaesthetist account.
- Walk-in, walk-out, with walking encouraged from the outset.
- Compression afterwards, and a review appointment.
- A written estimate beforehand, with scheme authorisation submitted on your behalf.
Your assessment is performed by Dr Johan Blignaut and includes duplex mapping before treatment is recommended. Treatment is selected according to your venous anatomy, not simply according to the veins visible on the skin.
How the choice is made in practice
Most patients are not choosing between four options. After the duplex scan, usually one or two are clinically appropriate and the discussion is about those.
Treatment plans also commonly combine techniques — ablation of the refluxing trunk, then foam or cosmetic sclerotherapy for surface veins at a later session. Treating the trunk without the branches, or the branches without the trunk, is a frequent reason veins return.
If you would like an indication of whether assessment is worthwhile, our free 5-minute online vein screening is a good starting point. Otherwise contact your nearest vein centre and we will arrange a consultation and scan.
References
- De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. ESVS guideline
- Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 SVS, AVF and AVLS clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. J Vasc Surg Venous Lymphat Disord. 2023;11(2):231–61. Journal
- Almeida JI, Kaufman J, Göckeritz O, et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux (RECOVERY study). J Vasc Interv Radiol. 2009;20(6):752–9. Journal
- Wang X, Wang H, Zhang R, et al. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins: a meta-analysis. J Vasc Surg Venous Lymphat Disord. 2024. PubMed 38316290
- Parsi K. Complications of foam sclerotherapy. Phlebology. 2012;27 Suppl 1:60–5. Journal
Written and medically reviewed by Dr Johan Blignaut, MBChB (UOFS), FCS(SA), Specialist Surgeon.
Last medically reviewed: August 2026. This page is reviewed periodically and updated when clinical practice changes. It is general information, not medical advice – see our terms and medical disclaimer.