Thick varicose veins or tributary varicose veins usually have a deeper origin, which is why it is essential to carry out a colour Doppler ultrasound scan at diagnosis. In most cases they come from an alteration in the veins known as greater saphenous (internal saphenous) or lesser saphenous (external saphenous).

These main venous axes of the superficial venous system have an alteration in their valves. These valves prevent the blood from «falling» towards the feet, when it should be returning to the heart. In patients with thick varicose veins, these valves are often damaged so they do not perform their function. This causes all the other veins that lead to the saphenous veins to dilate due to an accumulation of blood that does not return correctly.

What does the treatment consist of?

First of all, it is necessary to distinguish whether the thick varicose veins come from an alteration in one of the saphenous veins or not. If there is evidence of saphenous vein dysfunction, in order to obtain a good result, it is necessary to annul the vein using an endovenous technique with a catheter.

Endovenous techniques can replace and even surpass conventional surgery, which consists of stripping the pathological veins.

At Delarra we can offer all types of endovenous catheter techniques:

MOCA (mechanical-chemical occlusion): Clarivein®, Flebogrif®.

Glue occlusion (cyanoacrylate): Venablock®, Venaseal®.

THERMOABLATION: Latest generation NeoV 1940 endovenous laser.

Dr Cosín is an international reference and trainer of users in some of them (Clarivein®, Flebogrif® and Venablock®). He has performed more than 1000 Clarivein® cases and collaborates with Merit Medical (South Jordan, UT USA) in the dissemination and improvement of this procedure.

Once the source of the problem has been controlled, after treating the diseased saphenous vein, the most visible thick varicose veins undergo ECO-GUIDED FOAM SCLEROSIS.

This treatment is carried out in sessions, in which a small needle is used to inject the sclerosing foam well distributed in the varicose veins. The eco-guided injection consists of choosing the exact injection site of the product by means of the ultrasound image.

In specific cases in which we wish to complete the entire treatment in ONE SESSION (e.g. patients who live far away), this is also possible.

We combine endovenous catheter treatment with surgical microphlebectomy to eliminate varicose veins in a single procedure..


Recovery: NONE OF THESE PROCEDURES REQUIRE DOWNTIME. However, it is necessary to take into account not to practice intense physical activity for a few days-weeks, that is subsequently adapted.

When it works: Initially, there is no major discomfort and everything looks the same. After about 5-7 days (and sometimes even longer) pain and swelling may appear in the treated veins. This is normal and part of the treatment. Generally it is not necessary to take anything..

Number of sessions: The important thing about this treatment for an aesthetically excellent aesthetic result, is to approach it without haste. It usually takes between 3 and 5 sessions, but they are so far apart that they can last for months. From the first treatment, the changes are already noticeable.

Treatment duration: If it is an intravenous saphenous vein treatment, it takes about 60 minutes (although much of the time is pre and post preparation).

Where to apply it: Always from more proximal and larger veins (thighs) and later in the distal veins (legs and ankles). This may change depending on the case.

Pain: Treatments using the intravenous technique are somewhat more complicated, but only a small amount of local anaesthetic is needed at the point of entry. NO CUTS ARE MADE AND THERE ARE NO STITCHES. Foam sclerosis is performed with very fine needles. The prick is noticeable but not uncomfortable. The injection of the sclerosing foam is usually painless.

Post treatment tips:

You can lead a normal life once the treatment is finished. It is preferable to come accompanied on the first day of treatment.

Avoid extreme sport in the next 14 days.

We generally recommend wearing compression stockings between 7 and 21 days after treatment. They are worn during the day, although initially it may be requested to sleep with them as well.

Avoid the sun.

Combination with other treatments: If there are also spider veins, there is no problem in treating both types of varicose veins at the same time. Sometimes, it is best to start with thick telangiectasia and then proceed with the rest.

Adverse effects:

Pigmentation: generally due to the use of a certain type of product or a very high

concentration, a brownish shade may appear as a stain on the most noticeable varicose veins or thick varicose veins. OUR OBSESSION IS TO AVOID STAINS. Obviously, we do not want to exchange varicose veins for spots. For this, the technique and strategy used is of utmost importance, to be meticulous and to expect a good collaboration in the recommendations from the patient.

Matting: This undesired effect consists of the appearance of an area of pinkish appearance on the area where the spider veins were previously located. It consists of the appearance of small micro varicose veins that give the skin this tone. It is more difficult to foresee and control. It is usually related to hormonal influence, the technique used and personal susceptibility. There are ways to minimise and eliminate it. The most frequent sites are the outer thigh and inside of the knees.