Vein, vein, go away! Thirty years ago the appearance of a varicose vein meant the end of skirts and a life condemned to pants and compression stockings. Today, with myriad treatment options available, getting a varicose vein is nothing more than a nuisance. Here, vein expert Dr. Sanjoy Kundu of the Vein Institute of Toronto gives us advice on how to beat the vein for good.

Find the cause
The only way you can truly know what's causing varicose veins to appear - and the best way to treat them - is by booking an ultrasound. Most varicose veins are a result of a faulty valve in the main draining vein of the leg. When the valve is faulty it causes the blood to backflow and overflow smaller, less "competent" veins, which then bloat with the unexpected pressure and become visible varicose veins. In 10 per cent of cases, though, the vein is an isolated, abnormal vein that is less serious and easier to treat.

1. Creams and pills
   If compression stockings are not the avenue for you, you could try an over-the-counter cream like Invisi-Vein by Venus Naturals (www.venusnaturals.com), whose ingredients include herbal circulation remedies like calendula extract (known for its anti-inflammatory capabilities) and vitamin E.
   
   Another over-the-counter method that has been flooding the market lately is pills containing horse chestnut, such as Venarin (www.venarin.com) by Nutrica. Horse chestnut is a herbal extract whose properties, according to the Mayo Clinic, can significantly reduce pain and varicose vein size and may actually be as effective a treatment as compression stockings.
   
   But do they work? Although these products are good sellers, Dr. Kundu dismisses creams and pills as treatment options, stating, "I've seen a lot of patients that have tried many different creams and pills, and nothing has yet to work. Once the varicose vein is there, there is an underlying problem that cannot be solved by these types of products."
   
   
2. Compression stockings
   The least invasive and first course of action for any type of varicose veins should be compression stockings. Though unflattering, compression stockings relieve pressure on varicose veins and aid in circulation. "Be aware," warns Dr. Kundu, "although compression stockings help patients physically feel better, it is not a cure. As soon as the stockings come off the veins will come back."
   
   
3. Surgical stripping (ligation)
   For the past 30 years, surgical stripping has been the treatment option recommended by most doctors for the relief of varicose veins. To perform surgical stripping (also know as ligation), the doctor begins by making a number of small cuts from the groin to just below the knee, ties off (ligates) the abnormal vein and then removes the vein entirely. This procedure is done under general anaesthetic with a recovery time of four to six weeks and a 75 per cent success rate.
   
   Surgical stripping is still a popular surgery today because it is the only varicose vein procedure covered by most provincial health plans, and is still the most widely used treatment option for varicose veins.
   
   
4. Endovenous Laser Ablation
   In the past 10 years a new varicose vein treatment, Endovenous Laser Ablation, has been turning heads in the dermatological community. This treatment is a minimally invasive procedure and is performed in the doctor's office with local anaesthetic. With the patient lying on his or her back, the doctor inserts a small hollow tube into the main draining vein of the leg and uses lasers to seal off the vein. With the vein sealed off, the blood is forced to flow through a secondary venous system, which relieves pressure on the bloated, abnormal varicose veins and allows them to shrink back to normal, invisible size. This procedure has a recovery time of about two weeks with a 90 per cent success rate.
   
   Because of the high success rate and fast recovery time, Endovenous Laser Ablation is slowly becoming known as the most effective means for treatment of varicose veins. The average cost for an ablation is around $2,500 for one leg and $5,000 for both, which keeps this procedure from being the most widely used surgery.
   
   
5. Sclerotherapy
   Sclerotherapy is a technique whereby the patient is injected with a salt solution through a small needle into the dilated or abnormal vein. The solution irritates the lining of the vein and causes it, over time, to turn into scar tissue, which will eventually be reabsorbed into the body. This procedure should only be tried by patients who do not have a problem with the valve in main draining vein of their leg, or for patients who have had their main draining vein ligated or ablated; otherwise, there is a 50 per cent chance that the varicose vein will reappear.
   
   Prevention
   Here are some simple tips to keep the veins away for good:

• Don't cross your legs when sitting.
• Exercise regularly to increase circulation and to allow blood to move freely through your legs.
• Elevate your legs when resting as much as possible.
• Avoid standing or sitting for long periods of time.
• Avoid wearing tight clothes, especially at the waist.