The short answer is that all types of treatment are effective, but it will depend on when and where they are used.
Foam sclerotherapy is almost completely painless, but frequently requires multiple visits and is more prone to recurrence than the other techniques. The chemical used to treat the vein is mixed with air (usually) into a foam before injection. When it is injected into the vein the foam fills it, replacing the blood temprarily to allow the chemical to contact and destroy the cells lining the vein (this is the crucial part of any of the vein treatments). The foam dissolves and the vein collapses. Over time the collapsed vein scars up and shrinks so is unable to fill with blood. The technique is most suited to smaller, isolated, veins although it can be effective for larger and longer veins, particularly for those that are just under the skin and are extremely wobbly.
Surgery is the most common and traditional form of treatment. The results are dependent on the expertise of the surgeon, their knowledge of the disease and, to avoid the more common complications, precise technique. It usually involves being put to sleep, and often multiple surgical woulds, albeit small ones. The vein is disconnected from the body and stripped away, this removes the whole vein, and with it the lining cells. Blood fills the space left and this ultimately is absorbed by the body leaving only internal, invisible scar tissue. In expert hands surgery is highly effective and durable, but it is dependent on the surgeons expertise. See a specialist vascular surgeon of the best results.
The down-side of surgery is that it requires a hospital admission usually, and the wounds are prone to infection, bleeding, significant bruising, ooze and numbness; this can continue for several weeks or months after the initial surgery. It is also a relatively painful recovery initially.
The desire to avoid the surgery related complications of varicose vein operations has provided the impetus for the development of so called minimally invasive techniques; laser and RF ablation.
Both techniques are similar in the method of treatment and outcomes, but differ in patient experience. Lasers and RF catheters are introduced to the vein through a needle inserted into the vein. The patient is usually awake, and the procedure can be performed in an ‘office’ setting. Laser treatment requires the use of specially equipped rooms to prevent dangerous laser light causing unwanted injury outside of the operative area. Both techniques involve accurate positioning inside the vein using a live ultrasound scan image. This means that the surgeon can see exactly which vein he or she is treating for its full length (not the case with traditional surgery). Both techniques require the injection of an anaesthtising fluid around the vein – again under scan image guidance. The difference between the techniques lies in the intensity of the treatment. Lasers vapourise the cells lining the vein (them again) at extremely high temperatures of upto 700 Celsius in a continuous ‘pull through’, RF ablation uses heat at 120 Celsius over a length of 3 or 7 cm over a 20 second period, effectively ‘poaching’ the cells within the vein.
Studies have shown that RF ablation is the gentlest of the surgical techniques. It has superb durability with the least pain for the patient.
In summary, all techniques have their advantages and disadvantages and no single technique fits all veins. For the best treatment of varicose veins one needs a full expert assessment by a specialist in vascular surgery capable of delivering the spectrum of treatments. Many surgeons and medical practitioners will provide varicose vein treatments but, to avoid disappointment, and to reduce the chance of recurring veins and complications, please ensure the one that you see is a vascular specialist.