Spider Vein Treatment Options
The treatment of spider veins has greatly improved in the last ten years. Several different treatment types are used to treat spider veins: sclerotherapy, laser, ohmic thermolysis, and intense pulse light (IPL). Most patients require a combination of treatments for the best result. Many times your doctor will perform an ultrasound to rule out underlying causes of spider veins.

Your First Appointment: Examination and Ultra sound?
Typically, your first appointment is a consult and it is important not to wear creams or lotions on your legs. At this appointment, you will fill out the required paperwork. The doctor will do an examination of your legs and perform an ultra sound.

An ultra sound (US) is a noninvasive test that uses sound waves to create images. The US provides the doctor with detailed information about your venous system. The US will show blood flow, which will demonstrate where the reflux is occurring. Your doctor can easily determine where your veins are leaking and other serious vein conditions can be ruled out.

At your initial visit, the doctor may perform a few injections to test your response to the chemical solution used. Based on your response, the amount or type of chemical solution may be adjusted. Often times it takes multiple sessions for each leg. Pain is minimal or you may not have any pain during your treatment. Patients often report a slight burning or stinging sensation. The doctor may also test the laser or ohmic thermolysis on a spider vein to see how you react to these devices.

Sclerotherapy - Most Times Used for Spider Vein Treatment
This technique involves injecting a problem vein with a chemical solution (sclerosant). This is simple to do, performed in a short office visit, painless and requires no anesthetic. The chemical solution causes the blood vessel to close and it will eventually disappear. Sclerotherapy is the gold standard for treating spider veins and is also used to treat certain varicose veins.

How Does Sclerotherapy Work?
A chemical solution is injected, using a needle, into a dilated blood vessel. The chemical solution causes inflammation, which makes the walls of the vein stick together. Because of this, the treated vessel can no longer hold blood and it scars up and is eventually reabsorbed by the body.

There are two types of sclerotherapy used, liquid and foamed. Foam is made by mixing the sclerotherapy solution with air or C02. The type used depends on the size or the vein or your presenting problems. For more information go to www.bushvenouslectures.com and visit the blog.

What Can I Expect After My Treatment?
You can return to your normal activities right after your treatment.

Some patients go back to work after being treated. Patients are told that they will look worse before they look better.

With sclerotherapy, there is always bruising and clotting of treated veins.

Some people clear up in 1- 2 treatments and some people require 5-6 treatments.

Lasers
Many lasers are used in the treatment of spider veins. Lasers vary in wavelength and ability to effect damage. The most often used wavelengths are the 940 nm and the 1064 nm. Lasers speed up the treatment of spider veins by causing heat damage to the veins. The heat damages the vessel lining causing the veins to become smaller. In most cases, sclerotherapy is also used. The combination of heat and sclerotherapy gives a quicker resolution for a superior cosmetic result.

Complications of laser therapy are mostly related to skin damage but if done properly, this is rare. Patients with darker skin types cannot have laser treatment for veins.

Ohmic Thermolysis
This relatively new treatment is done by directly placing a small needle in the spider vein and focusing heat energy (radio frequency). This device is safe for all skin types. It works better than all other methods of treatment for small reddish veins that are difficult to inject.

Complications are almost non-existent, but visible tracts may be present as the vein undergoes resolution and this is temporary. This resolves in 2-6 weeks for most patients.

Intense Pulsed Light (IPL)
This method of treatment is used for smaller veins in fair skin types. Effective for some patients, the technique requires experience by the provider and there is more discomfort than other treatments. IPL in the treatment of spider veins has been replaced in most part by newer technologies.

Ron Bush, MD, FACS
Peggy Bush, APN, CNS, MSN