What Are The Best Treatments For Spider Veins?

We often see patients in our clinic who are wondering what is the best treatment for spider veins?  Inevitably, this is a question about whether sclerotherapy or laser therapy for spider veins is best.  As you might expect, the answer isn’t so simple and the answer lies in the individual assessment of each patient.

To begin with, vein treatment is influenced by multiple factors, including what you are treating, the location, and how large the veins are.  However, before beginning any treatment, our vein doctors want to know if there is an underlying venous disorder.

Treatment with Sclerotherapy: Sclerotherapy is a procedure that uses a medication, called a sclerosant, to collapse the targeted veins. This sclerosant can vary, however, reputable vein clinics will use polidocanol–the safest and effective choice at 0.25%-1% concentration depending on the size of the targeted vein.  The medication is injected into the unhealthy veins with direct visualization or in some cases with ultrasound or infra-red light. Over the next couple weeks (or months for larger veins) the veins will slowly be broken down and absorbed by your body. One treatment is expected to produce 50-60% improvement and many patients will require two or three sessions for complete elimination.

Treatment with Laser: Laser technology focuses a beam of energy on unhealthy spider veins that are absorbed by the blood vessel. This causes the vein to close down through heat and is gradually removed by the body over the course of several weeks.

 What Causes Spider Veins?

The venous system is a carrying tank for circulating blood, generally holding up to 70% of the blood volume at any given time.  Circulating blood within veins is returned back to the heart using complex interactions between valves and muscle pump function.

A dysfunctional venous system is the result of damage to vein walls and valves that result in varicose vein problems.   Naturally, blood pools in these veins due to gravity, resulting in high pressure within the veins. Whereas the deeper veins are supported by the muscles within our legs, the superficial veins that cause varicose veins will stretch.  Over time, these vein walls can become weakened from the constant pressure and resulting in vein injury. The size of the veins will gradually increase and lead to valve dysfunction and venous reflux. The visual presentation of this is commonly seen as spider and varicose veins on the legs.

Venous insufficiency is more common in individuals who sit or stand for prolonged periods, increasing age, females, obesity, and most importantly patients with a family history.  Developing varicose veins is linked to our DNA and this affects men and women alike.

Minimally Invasive Varicose Veins Treatments

The most surprising fact to many patients seeking varicose vein removal is that surgery is not needed.  Many patients recall stories about their parents undergoing extensive vein stripping procedures with painful and extended recovery periods.  Those days are long gone. Instead, today’s procedures are minimally-invasive and suited for all types of vein conditions.

These minimally invasive treatments for varicose veins include:

  • VenaSeal: Like most other vein treatments today, VenaSeal is also catheter-based technology. However,  unlike ablation, the catheter is used to inject a medical adhesive that fuses the diseased vein closed. Over time, the vein is reabsorbed by the body.
  • Radiofrequency ablation: Catheter-based technology that delivers radiofrequency generated heat to the blood vessel walls.  The procedure is done with only small amounts of local anesthetic and can be completed in less than 30 minutes.
  • Sclerotherapy: A medicated solution is injected in either liquid or aerated form (foam sclerotherapy). This medication acts as a sclerosant and disrupts the walls of diseased veins causing them to collapse and eventually be absorbed.
  • Ambulatory Phlebectomy: This requires the most skill and patience, but still is minimally invasive.  Tiny incisions are made over large, protuberant veins so that they can be directly removed.  Unlike stripping, these procedures are done within the office and patients do not require any downtime.  The best part, any large visible varicose veins are immediately removed leading to dramatic skin improvements.
  • Clarivein: Another catheter-based technique with some special uses in certain varicose vein anatomy.  In this case, mechanical force and sclerosant are used to eliminate diseased veins.
Sclerotherapy vs Laser treatment
In general, our vein doctors prefer sclerotherapy for the treatment of spider veins due to the increased number of vein types that can be treated with sclerosant injections.  Sclerotherapy is effective in both small and larger sized veins, including reticular and varicose veins. Laser therapy is not as effective as sclerotherapy with larger reticular or varicose veins.  However, there are some situations where laser therapy is preferred. This includes spider veins on the face or feet where injection can be contra-indicated. Additionally, very fine veins that are difficult to inject will be suitable for laser treatment.  Ultimately, your vein doctor will plan treatments according to your individual anatomy and in some cases, both forms of treatment may be required.

Who Treats Spider Veins?

vein specialist is a doctor that specializes in treating varicose veins and the underlying condition, venous insufficiency.  Ideally, your vein doctor in Wayne should have completed formal training in endovenous procedures during his/her residency and fellowship training.  Qualified vein specialists will possess a training background in vascular surgery, interventional radiology or interventional cardiology. A recognition of competency is achieved with board-certification in one of these specialties and should be readily available to discerning patients.  Other specialties including pain management, internal medicine, or family medicine do not hold any formalized training in surgical or minimally-invasive endovascular procedures. Their board-certifications are well deserved, however not in the treatment of varicose veins.

How do you feel about the clinic itself?

Successful outcomes with spider and varicose vein treatment depends on a shared process between you and your provider. An attentive vein doctor will take the time to understand your goals with vein treatment and provide honest feedback. And, if you are comfortable during your initial vein consultation, then you are also increasingly likely to have a positive experience during treatment.

Why Princeton Vascular Center?

At our vein clinic in Wayne NJ, you can rest assured that you will be in the care of board-certified vascular specialists.  Dr. Alissa Brotman-O’Neill has been consistently named to Top Doc in SJ Magazine, NJ Top Doctors, Talk of the Town, and Compassionate Doctor on Vitals.  As President-elect for the New Jersey Vascular Surgical Society, she is committed to remaining up to date on all the latest research and technologies in the treatment of vein disease.  For more information, please schedule your spider vein and varicose vein consultation today.

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