Varicose Vein Treatment
A varicose vein is rarely just a varicose vein. The treatment fits the map underneath.
At Palazzo Manzoni in Brescia, varicose vein treatment starts from the ecocolordoppler, not from the surface. Ultrasound-guided foam sclerotherapy or endovenous laser, chosen by indication. Led by Prof. Edoardo Cervi, with Dr. Fabio Viotti for endovenous laser.
The varicose vein programme at Palazzo Manzoni in Brescia is led by Prof. Edoardo Cervi, with endovenous laser performed by Prof. Cervi and Dr. Fabio Viotti. Every plan starts from a venous ecocolordoppler (the imaging exam that maps the morphology and flow of the venous system) and ends when imaging confirms the reflux has been resolved.
Ecocolordoppler first
Every treatment starts with the venous map.
Ambulatory, walk in walk out
Local technique, no general anaesthesia, immediate return to activity.
Closure, not stripping
Chemical (sclerotherapy) or thermal (laser) closure replaces the old stripping.
Same specialist, every session
One vascular surgeon, from first visit through follow-up.
What Brought You Here
You stopped wearing what you used to wear long before the legs forced the issue.
You felt the heaviness creep in by late afternoon. You started crossing the legs differently. You stopped wearing skirts, or shorts, or anything that made the veins visible. You were told it was hereditary, that it was hormonal, that you’d brought it on with the wrong shoes or the wrong job or too many hours standing.
You were told to use compression. You were told to wait. If you’ve reached this page, the working-around-it phase is over.
What you need now is a specialist who will examine the legs, place the ultrasound probe on the right segments, and tell you honestly which vessel is doing what under the surface and which technique will close it for good. That is what your first appointment at Palazzo Manzoni is for.
A Clear Path Forward
A precise diagnosis, then the right technique for your specific venous map
Varicose vein treatment only works well when the technique matches the lesion, the patient, and the underlying reflux. A varicose vein treated without mapping the system that feeds it is a varicose vein that comes back. The ecocolordoppler is the imprescindible first step. The treatment is what follows.
The programme is led by Prof. Edoardo Cervi, a general and vascular surgeon with phlebology subspecialisation, with endovenous laser also performed by Dr. Fabio Viotti.
01
A venous map before any procedure
Every plan starts from the ecocolordoppler venoso, the ultrasound examination that visualises both the morphology of the veins and the direction of the blood flow inside them. Without it, the conversation is guesswork.
02
Closure techniques chosen by indication, not by inventory
Ultrasound-guided foam sclerotherapy is the workhorse for most varicose veins. Endovenous laser is preferred for the saphenous trunk and selected tributaries. Liquid sclerotherapy and cryosclerotherapy address smaller and surface vessels. The technique fits the lesion.
03
A vascular surgeon, not a procedure operator
Prof. Cervi is a general and vascular surgeon with phlebology subspecialisation. If your venous picture is straightforward, the technique is straightforward. If it isn’t, the conversation goes deeper than a leaflet.
04
Follow-up that ends with imaging, not with appearances
A varicose vein looks better the moment the surface vein has been closed. The actual question (is the underlying reflux gone?) is answered by a follow-up ecocolordoppler, not by what the leg looks like a week later.
Three Conversations
Three varicose vein problems,
two closure techniques
A varicose vein you can see and feel is most often the surface marker of an insufficient saphenous system upstream. When the saphenous trunk is the source, the old answer was stripping; the current answer is closure from inside the vein. The technique is chosen from the ecocolordoppler, not from a leaflet.
Here is how the two main closure techniques compare. The choice is made with you, after your ecocolordoppler.
Technique 01
Ultrasound-guided foam sclerotherapy
Best for
Visible varicose veins of medium and large diameter, with confirmed reflux, and the residual tributaries after a saphenous closure.
Feels like
A fine needle injection, comparable to a venous blood draw, uncomfortable rather than painful. No general or local anaesthesia.
Recovery
Walk in, walk out. 15 to 30 minutes per session, class II compression for two to three weeks, two to four sessions about a month apart.
Trade-offs
The closed vein is reabsorbed over weeks, not removed. A small share of patients develop transient brown pigmentation along the treated path.
Technique 02
Endovenous laser (EVLA)
Best for
Confirmed reflux of the great or small saphenous trunk, in patients who wish to avoid the classic stripping. The replacement for safenectomia.
Feels like
A single needle puncture and tumescent local anaesthesia along the vein. Patients describe pressure or pulling, not pain. No general or spinal.
Recovery
Ambulatory, 30 to 60 minutes, walk out the same day. Class II compression, normal activity from day one, usually a single session for the main trunk.
Trade-offs
A cord-like sensation along the laser path for a few weeks. The technique is operator-dependent, and residual tributaries usually need complementary foam sclerotherapy.
Which one is yours?
That’s what the ecocolordoppler is for.
Your Journey
From “the legs are no longer right”
to “the venous map is stable.”
Step 01
Your first examination
A focused phlebological examination, a history of when symptoms appeared and how they evolve through the day, and a review of any prior imaging you bring. The ecocolordoppler is performed in the same visit, with the probe on the venous segments that matter.
Step 02
Your personalised plan
You leave the first consultation knowing what the venous system is doing, which segments are competent and which are not, and what each technique would and would not do for you. The written plan follows: number of sessions, technique by segment, expected timeline.
Step 03
The treatment, in the right setting
Ultrasound-guided foam sclerotherapy is ambulatory, typically 15 to 30 minutes per session, performed under ecocolordoppler control with local anaesthesia where required. Endovenous laser is performed at Palazzo Manzoni, also ambulatory, with a single needle puncture and the patient walking out the same day.
Step 04
Compression and return to activity
Elasto-compressive stockings (typically class II) for the first two to three weeks after each session, to optimise the adherence of the sclerosing agent to the vessel wall. Normal daily activity, including work and walking, from the same day. Strenuous exercise is reintroduced after the first follow-up.
Step 05
Follow-up, imaging-based
A follow-up ecocolordoppler at the agreed interval. The question is not whether the leg looks better (it almost certainly does). The question is whether the underlying reflux has been resolved. The pathway closes when the imaging confirms it.
What it looks like on the other side
A leg that goes back
to being a leg
The first thing most patients notice isn’t the absence of the vein. It’s the absence of the vein from their thinking. The afternoon that doesn’t start with a calculation. The evening that ends without the heaviness. The dress, the shorts, the swim you stopped without quite admitting it.
In their own words
Fifteen years of being told it was “just a vein.” Three sessions of foam sclerotherapy and the leg felt mine again by evening. I should have come in a decade earlier.
I’d been told the saphenous had to come out, with a scar from groin to ankle. Prof. Cervi mapped the vein on the ecocolordoppler and offered the endovenous laser. One puncture, one session, walking out the same day. The follow-up imaging confirmed the closure.
The visible vein on my calf was actually the tip of a much bigger problem upstream. Once the ecocolordoppler made it clear, the plan was different from what I’d been told elsewhere. The legs feel ten years younger.
Who Leads Varicose Vein Treatment
Prof. Edoardo Cervi
Vascular surgeon and phlebology lead. Ultrasound-guided foam sclerotherapy, endovenous laser, vascular diagnostics.
Vascular surgeon and phlebology lead
general and vascular surgery with phlebology subspecialisation
Full venous and arterial diagnostics
ecocolordoppler of venous, arterial, supra-aortic, aortic and abdominal vessels
Minimally invasive techniques
ultrasound-guided foam sclerotherapy, endovenous laser, radiofrequency and hemorrhoid treatment by foam and radiofrequency
Same specialist, every session
continuity from the first ecocolordoppler through every session and follow-up
“A varicose vein is rarely just a varicose vein. It is, very often, the visible tip of an insufficiency that started further upstream. The ecocolordoppler is what changes the question from ‘how do we make this segment look better’ into ‘how do we close what is actually causing it.’ Today’s techniques are minimally invasive, ambulatory, indolent. There is no longer a reason to live with the legs you’ve been told to live with.”
When Time Is Not Neutral
Some varicose veins can wait. Many cannot.
A competent venous system is silent. An incompetent one is patient: it does its quietest work over years, while you adapt around it. The heaviness becomes normal. The evening swelling becomes normal. The calf cramps at night become normal. They are not normal. They are the body’s way of saying that blood is stagnating in the vessels that should be moving it back to the heart.
A varicose vein left to its own course can develop superficial thrombosis (varicophlebitis), a painful inflammation of the surface vein that in selected patients reaches the deep venous system and becomes a deep venous thrombosis. The reflux that feeds the visible vein progresses year on year, recruiting new tributaries. The skin over the calf, fed for years by stagnant venous blood, eventually thickens, darkens, and in advanced cases ulcerates.
→Ultrasound-guided foam sclerotherapy
The workhorse for visible varicose veins of medium and large diameter, and for residual tributaries after a saphenous closure.
→Endovenous laser (EVLA)
Closure of the saphenous trunk from inside the vein, the modern replacement for stripping, in a single ambulatory session.
→Radiofrequency
A thermal technique very similar to endovenous laser, with the same indications and a similar recovery profile.
None of this is a reason to panic. It is a reason to be examined. For most patients, the first ecocolordoppler is reassurance. For others, the answer is “earlier is better.” The waiting in the unknown is what costs you most.
Common Questions
Common questions
about varicose vein treatment
How do I know if I need treatment for a varicose vein?
Not every visible vein needs treatment. The decision depends on the size of the vein, the underlying reflux on ecocolordoppler, the symptoms (heaviness, evening swelling, night cramps, restless legs), and the patient’s history (prior superficial thrombosis, family history). Visible veins with symptoms and confirmed reflux are usually best treated. Visible veins without reflux can often be managed cosmetically or conservatively. The honest answer comes from the consultation and the ecocolordoppler.
What is the difference between sclerotherapy and endovenous laser?
Sclerotherapy closes a vein chemically, by injecting a sclerosing agent (in liquid or foam form) that triggers a controlled inflammatory reaction and progressive obliteration of the treated vessel. Endovenous laser closes a vein thermally, by introducing a thin laser fibre inside the vein and emitting heat that seals it. Both are alternatives to the old stripping. Sclerotherapy is preferred for varicose tributaries and small to medium varices. Endovenous laser is preferred for the saphenous trunk and selected larger tributaries.
How many sessions are typically required?
For ultrasound-guided foam sclerotherapy, two to four sessions spaced about a month apart, depending on the volume of disease. For endovenous laser, typically a single session for the main treated vein, often followed by complementary sclerotherapy of the residual tributaries. The exact number is established after the ecocolordoppler.
Is the procedure painful?
Minimally. Foam sclerotherapy is performed under ultrasound guidance with a fine needle; the injection itself is comparable to a venous blood draw. Endovenous laser is performed under local anaesthesia (tumescent technique) along the path of the vein; patients describe pressure rather than pain. There is no general anaesthesia for either technique.
Will I need to wear compression stockings, and for how long?
Yes. Elasto-compressive stockings, typically class II, are worn for the first two to three weeks after each session, to optimise the adherence of the sclerosing agent to the vessel wall and to support venous return during the healing phase.
When can I return to my activities?
Daily activity, including work and walking, from the same day. Strenuous exercise is reintroduced after the first follow-up (typically two to three weeks). Long-haul travel, hot baths and saunas are best avoided in the immediate post-procedure window.
What about the old “stripping” of the saphenous vein?
Stripping, also known as safenectomia, was the gold standard until the endovascular ablative techniques (endovenous laser, radiofrequency, ultrasound-guided foam) replaced it for almost every indication. Stripping is today reserved for selected cases with very specific anatomy. It is no longer the default conversation.
Can varicose veins come back after treatment?
Recurrence is possible but largely depends on how the original treatment plan was built. Treating only the visible surface vein, without mapping and addressing the upstream reflux, is the most common reason for “recurrence.” When the plan is built from the ecocolordoppler and follows the reflux back to its source, durable closure is the realistic expectation, with periodic check-ups thereafter.
Can I have treatment if I am pregnant or breastfeeding?
Sclerotherapy and endovenous laser are typically deferred during pregnancy and the immediate postpartum period. Pregnancy itself is a strong trigger for varicose vein progression, and many patients schedule their treatment plan after completing the desired number of pregnancies. The first consultation can establish the right timing for your specific situation.
How much does varicose vein treatment cost at Palazzo Manzoni?
Cost depends on the technique chosen (sclerotherapy vs endovenous laser) and the number of sessions required, which is established after the ecocolordoppler. After your initial examination and the diagnostic mapping, you receive a detailed, transparent estimate covering the diagnostic ecocolordoppler, the procedures themselves, and the follow-up plan, itemised clearly with no hidden fees.
Where is Palazzo Manzoni, and do I need a referral?
Istituto Chirurgico Palazzo Manzoni is at Via dei Mille 14 in central Brescia, reachable from anywhere in Lombardy, including Milan (about one hour). No referral required to book a vascular consultation.
Who leads the varicose vein programme?
The programme is led by Prof. Edoardo Cervi, with endovenous laser also performed by Dr. Fabio Viotti. Care is delivered by the team, with continuity from the first ecocolordoppler through every session and follow-up.
Take the Next Step
The legs you stopped wearing on display were never the problem.
The map underneath was.
At Palazzo Manzoni in Brescia, your varicose vein consultation is thorough, honest, and built around the ecocolordoppler map of your specific venous system.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
01
Get in touch
Call, email, WhatsApp, or book online.
02
Be examined with ecocolordoppler
Specialist venous mapping by Prof. Cervi or Dr. Viotti, with the team that will see you through.
03
Move forward, with a plan
A plan that fits your specific venous map.
Content reviewed by Prof. Edoardo Cervi, head of Vascular Surgery.