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Sclerotherapy Your physician will develop a treatment plan for your individual case. Spider veins can be successfully treated with injection sclerotherapy. Sclerotherapy is the most popular method of eliminating spider veins. This is the “gold standard” and is more effective and less expensive than lasers (for spider veins, not varicose veins). Sotradecol is injected into the veins using very tiny needles.

This solution causes an irritation to the inner lining of the vein resulting in closure of the vein. The vein stops carrying blood and therefore disappears with time. The majority of people who have sclerotherapy performed have satisfying results and little discomfort.

Treatment differs from patient to patient, depending on the extent of the varicosities (size and number). An average of three to four treatments is required in most cases to achieve a 70%-80% clearing; 100% is not a realistic goal. The treatment sessions last approximately 15 minutes and are done at four to six week intervals to achieve optimal results.

Sclerotherapeutic Progress After completion of the initial series of recommended treatments, successfully treated veins are either gone or are much less noticeable. However, patients with a history of spider veins tend to develop new ones (with or without treatment) and a yearly touch up may become necessary. If you have leaking valves in your deep veins, you will likely continue to develop spider veins if the underlying cause is not treated.

Sclerotherapy is a treatment for spider veins, not a cure.

Foam Sclerotherapy
The latest non-surgical treatment of varicose veins is the use of ultrasound-guided foam sclerotherapy injections. The use of foam in the treatment of varicose veins started in 1944, but did not gain popularity until the early 1990's. A report from Europe in 2001 with five-year follow-up showed that 80% of the treated veins were obliterated and all superficial branches had vanished in 95% of the treated legs. The largest experience comes from a study from France where 10,263 treatments were performed; 80% of the injected veins were reticular varicosities or truncal varicosities. The other 20% were directly into the saphenous veins. In over 10,000 treatments only 20 adverse events were reported, an incidence of only 0.19%

Treatment is performed in the office with no need for sedation or anesthesia. The technique is to place a needle into the varicose vein and the agent is injected. Ultrasound easily images the agent in the veins and is used for monitoring the treatment. The foam is observed flowing into the veins to be treated and is stopped by pressure from the ultrasound probe and re-directed by massage and elevation. This selective treatment of varicosities is more selective and complete than surgical removal. Patients treated in this manner wear an elastic bandage for 48 hours and may drive home alone or with a companion. There are minimal activity limitations and no supplemental treatments are needed.

Treatment of varicose veins by foam injection consists of several appointments. While only a single injection session may be sufficient, touch-up sessions are advised to ensure the completeness of the treatment. If recurrences or new veins appear, they can be treated as they appear as necessary.

The long-term success of foam sclerotherapy beyond five years is yet to be determined. But the short-term efficiency is close to 90%. We feel that the use of ultrasound-guided foam sclerotherapy will decrease our need to perform surgery and this 5-year efficacy justifies the introduction of this technique into clinical practice.

Laser / Closure Procedure
(Endovenous Saphenous Vein Ablation)
Your physician will develop a treatment plan for your individual case. Varicose veins caused by reflux in the superficial saphenous vein can be successfully treated with endovenous ablation. Lasers and radiofrequency ablation (high energy ultrasound) have been used safely for many different medical applications throughout the body. In recent years, small fibers have been used successfully to deliver heat energy to treat varicose veins. These methods allow your doctor to close off the diseased superficial vein that contains leaking valves, thus preventing any further reflux (backwards flow of blood) into your varicose veins.

The procedure is usually performed in the doctor’s office with numbing medicine and Lorazepam, thus eliminating the need for hospitalization and general anesthesia. A laser catheter is placed into the diseased vein. Laser energy is delivered to close off the diseased vein. Recovery is quick. Patients are encouraged to return to normal activities the day after the procedure. The vast majority of patients have very satisfying results and little discomfort.

Conservative
Varicose veins may not require any treatment at all if they do not bother you and they don’t cause any symptoms of aching, swelling or skin changes. Conservative treatment includes life-style changes such as weight loss, exercise, elevation, and compression stockings. These methods have proven successful in reducing the pressure that builds up in your veins and can improve your symptoms.

Compression hose
Prescription strength compression stockings aid in the treatment of varicose veins by helping squeeze the blood back out of your legs, preventing congestion. This may relieve discomfort but patient compliance is very difficult. Ideally, compression stockings should be worn all day until you are able to elevate your legs at night. Patients routinely complain of heat and difficulty placing the stockings. However, they certainly do reduce discomfort and swelling associated with venous reflux and varicose veins.

Ambulatory phlebectomy
Often used after endovenous laser ablation, phlebectomy involves the actual removal of branches of varicose veins through tiny incisions in your skin that are usually closed with only tape strips. The skin is numbed with a local injection and special instruments are used to remove the veins through tiny incisions. In most cases, you can resume normal activities the following day. When you leave the office after phlebectomy, those big bulging veins that have bothered you for years will be gone!! Tiny spider veins may persist and can be treated with sclerotherapy if they do not go away.