Veins that are cosmetically unappealing or cause pain or other symptoms are prime candidates for treatment. There are two general treatment options: conservative measures, such as compression stockings or herbal remedies, and corrective measures such as sclerotherapy, surgery and light source/laser treatment. In some cases, a combination of treatment methods works best. A number of factors go into determining the right treatment for you, including your desired outcomes and the severity of your condition. It’s important to discuss your treatment options with a vein care specialist. If you don’t already have a specialist, you can use our physician finder tool to find one in your area.
Graduated compression stockings are first line of defense and a mainstay of conservative management of venous disease. Graduated compression stockings create a tight pressure around the foot and ankle that gradually decreases as it moves up the leg. This “graduated compression” promotes the normal flow of blood up the leg. Most vein specialist recommend that patients who suffer from spider veins, varicose veins, or venous insufficiency wear compression stockings. Compression stockings can also be used to supplement other forms of treatment.
Natural plant medicines may strengthen the vein wall or decrease the inflammation that often comes with vein disease. Horse chestnut extract is the most commonly recommended herbal preparation for venous disease. Although there is no documented evidence of its efficacy, there are many anecdotal reports of beneficial effects on the symptoms of vein disease.
Sclerotherapy is a common treatment for small (spider veins) and medium size (reticular) veins. A tiny needle is used to inject the veins with a solution (called a sclerosant) that irritates the lining of the vein. In response, the veins collapse and are reabsorbed. The surface veins are no longer visible. Depending on the size and location of the veins, different types and strengths of sclerosants are used. With this procedure, veins can be dealt with at an early stage, helping to prevent further complications.
You may need anywhere from one to several sclerotherapy sessions for any vein region. Depending on the type and number of veins being treated you may have one or several injections per session.
The procedure, performed in the doctor’s office, usually causes only minimal discomfort. Generally, no “recovery” time is needed after sclerotherapy, and patients can resume their regular activities immediately.
Possible complications of sclerotherapy include inadvertent intra-arterial injection, skin ulceration, hyperpigmentation (dark spots), telangiectatic matting (blush spots), superficial phlebitis, deep vein thrombosis (blood clots), and allergic reaction. Scarring and other complications are rare, but it’s important to talk with your specialist about your options to understand the advantages and disadvantages of every treatment option.
There are three types of endovenous procedures: Endovenous laser treatment, Endovenous radio frequency ablation and Ultrasound guided sclerotherapy (sometimes called echo-sclerotherapy).
Endovenous Laser Treatment
Endovenous laser treatment is a minimally invasive, in-office treatment alternative to surgical stripping of the great saphenous vein. Instead of removing the saphenous vein, it is sealed closed in place. The skin on the inside of the knee is anesthetized and a small laser fiber is inserted through a needle stick into the damaged vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut.
This procedure is done in-office under local anesthesia. Following the procedure, a bandage or compression hose is placed on the treated leg. Patients are able to walk immediately after the procedure and most individuals are able to return to work the next day.
Schematic of endovenous laser treatment.
Image courtesy of Diomed, Inc.
Endovenous Radio Frequency Ablation (Procedure)
Endovenous Radio Frequency Ablation is a minimally invasive, in-office treatment alternative to surgical stripping of the great saphenous vein. Instead of removing the saphenous vein, it is sealed closed in place. The skin on the inside of the knee is anesthetized and a radio-frequency catheter is inserted into the damaged vein through a needle stick in the skin. The catheter delivers radiofrequency energy to the vein wall causing it to heat. As the vein warms, it collapses and seals shut.
The procedure is generally done in an outpatient or in-office setting, under local anesthesia.
Following the procedure, the catheter is removed and a bandage or compression stocking is placed on the treated leg. Patients are able to walk immediately after the procedure and most individuals are able to return to work the next day.
Ultrasound Guided Sclerotherapy (Echo-Sclerotherapy)
Ultrasound Guided Sclerotherapy (Echo-Sclerotherapy) is another in-office treatment alternative to surgical stripping. With this technique and based on the clinical judgment of the doctor, sclerotherapy is done with either a liquid or “foamed” sclerosant, while the doctor visually monitors the vein on an ultrasound screen. This enables treatment of veins that can’t be seen because they are below the surface of the skin and would otherwise require surgical removal. Ultrasound imaging is used to guide a needle into the abnormal vein and deliver medication to destroy the lining of the blood vessel and seal it shut. Ultrasound guided sclerotherapy is primarily used to treat large veins beneath the surface of the skin.
There are several surgical options for the treatment of varicose veins. Surgery may be performed using local, spinal, or general anesthesia. Most patients return home the same day as the procedure. Surgery is generally used to treat large varicose veins. Every treatment option has advantages and disadvantages, so it’s important to discuss all of your treatment options with a vein specialist before deciding what’s right for you.
Traditional Ligation & Stripping
Traditional ligation & stripping of the great saphenous vein is usually performed in a hospital operating room or outpatient surgical center under general anesthesia. An incision is made in the groin, and the saphenous vein is tied off at its origin. Then a series of incisions are made in the leg and a wire “stripper” is inserted into the abnormal veins, which are then stripped out.
Possible complications of vein stripping are damage to surrounding nerves leading to numbness, damage to lymphatic tissue leading to chronic leg swelling. The surgery also leaves incision scars; however this treatment can provide relief to patients suffering from serious venous disorders. Talk to your physician about the risks and benefits of all your treatment options before making a decision.
PIN stripping is an updated method of vein stripping. This technique is performed in a hospital operating room or outpatient surgical center but can be done using either general anesthesia or local anesthesia with IV sedation. A small incision is made in the leg and the “PIN stripper” is inserted and advanced through the vein. The tip of the PIN stripper is sewn to the end of the vein and as the PIN stripper is removed, the vein is pulled in on itself and is “stripped” out.
Possible complications of PIN stripping are local numbness, incision scars, and allergic reaction to the local anesthetic (if used).
Ambulatory phlebectomy is a method of surgical removal of surface varicose veins. Ambulatory phlebectomy is usually performed in a doctor’s office using local anesthesia. The area surrounding the varicose vein clusters is flooded with anesthetic fluid. A needle is then used to make a puncture next to the varicose vein and a small hook is inserted into the needle hole and the varicose vein is grasped and removed. The punctures typically leave nearly imperceptible scars.
Varicose veins before and after ambulatory phlebectomy. Individual results can vary.
Photos courtesy of S. Zimmet, MD
After the vein has been removed by phlebectomy, a bandage and/or compression stocking is worn for a short period.
Ambulatory phlebectomy is often performed in conjunction with minimally invasive endovenous catheter procedures or PIN stripping. Possible complications of ambulatory phlebectomy are allergic reaction to the local anesthetic and local numbness.
Laser and intense pulsed light (IPL) can be used to treat small spider veins and facial redness. A light beam is pulsed through the skin and onto the veins in order to seal them off and cause them to dissolve. Light-based treatment is generally used only to treat small veins. Treatments may be combined with sclerotherapy, and multiple treatments are usually required.