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Diseases & Conditions

Treatment

There are three major treatments for varicose veins and spider veins. The most conservative approach is simply to wear properly fitting support hose, especially when the veins cause painful or uncomfortable symptoms. These stockings can generally be purchased at any surgical supply store and at some pharmacies. They come in below-the-knee, above-the-knee, and pantyhose styles. They also come in different compressions, varying from 15 to 20 mmHg and up to 40 to 50 mmHg.

Good skin hygiene, weight loss (if needed), and walking also can help treat varicose veins and spider veins.

Sclerotherapy, which has been available since the 1930s, is another treatment option. This procedure uses a highly concentrated saline solution or a specially made detergent that is injected directly into the vein, causing the vein to disappear gradually over three to six weeks. The procedure is simple, relatively inexpensive, and can be performed in an outpatient setting. Complications are minimal but do include staining, blisters, and – rarely – the formation of a skin ulcer. Patients are encouraged to maintain their active lifestyles immediately following the injections. They are able to drive themselves home after the procedure because no sedation is needed for this relatively painless procedure.

Another option is a newer device called PhotoDerm. This device uses heat energy from an intense pulse light to selectively damage or destroy abnormal veins. The advantage of this method is that no needles or sclerosing solutions are required, however there might be some minor discomfort. Side effects do occur, including discoloration or staining and blister formation.

Not all patients need treatment for their varicose veins or spider veins. Many people have no pain or other symptoms. For these individuals, no treatment is necessary, unless they want the veins removed for cosmetic reasons.

How are varicose veins treated?

Regular exercise, standing only when necessary, and elevating your legs while sitting and sleeping might keep your varicose and spider veins from getting worse. Wearing special elastic support stockings during daily activities also can provide extra support and relieve aching, sore legs. When you need to stand for long periods of time, take frequent breaks to sit down and elevate your feet.

Depending on the size and location, varicose and spider veins can be treated with surgery, injections (sclerotherapy), or laser surgery.

What is sclerotherapy?

Sclerotherapy is a non-surgical treatment option that involves injecting a chemical solution into the veins to make them collapse. Because the veins can no longer carry blood, they will eventually disappear. The work of carrying the blood is shifted to other healthy blood vessels nearby, improving circulation.

Sclerotherapy requires multiple sessions, since one to three injections are usually required to effectively treat any vein. Ten to 40 veins may be treated in one session. The same area should not be injected for four to six weeks to allow for complete healing, although other areas may be treated during this time.

The only discomfort during sclerotherapy is the sensation of small needle pricks. For two to four weeks after treatment, you will wear medical-grade support stockings. Walking and moderate exercise also can help speed recovery. Temporary reactions to the treatment might include slight swelling of the leg or foot, minor bruising, itching, redness, or mild soreness. Rare complications include telangiectatic matting (new, tiny blood vessels), skin ulcerations, and brown pigmentation around the treated vessels.

Once treated, the veins disappear over a period of six months and do not recur. However, sclerotherapy treatment cannot stop new varicose or spider veins from developing.

What are some other treatment options for dilated veins?

  • Photoderm – Intense, pulsed light can be used to treat small spider veins, certain sizes of varicose veins, and vascular birthmarks. This treatment might be recommended when sclerotherapy or laser therapy does not effectively treat the dilated vein. One to six treatments might be required to properly treat the area.
  • Laser therapy – Most effective for small facial and leg blood vessels, laser therapy heats the blood vessel and destroys it.
  • Surgical ligation/stripping – Severe varicose veins might require a surgical procedure in which the dilated vein is either removed or tied off through a small incision in the skin. The surgery is done in the hospital by a vascular surgeon.
  • VNUS catheter – This is a new technique that uses a radiofrequency device carried by a catheter to the incompetent (leaky) vein valve to seal off the varicose vein.

Cleveland Clinic Foundation offers a non-surgical procedure that uses laser light to eliminate spider veins, vascular birthmarks such as portwine stains, and facial blood vessels. It has been successful in treating vascular lesions that have not responded to other therapies such as sclerotherapy or electrosurgery.

It is an individualized treatment plan designed according to the patient's skin type and the characteristics of the lesion.

Q. What are the benefits of treatment with the Versapulse laser?

A. Treatment with the Versapulse laser offers the following benefits:

  • no needles or injections
  • no anesthesia required
  • very slight pain – treatment feels like a pinprick
  • minimal to no bruising
  • treatment time is about 15-30 minutes
  • only 1-5 sessions required to achieve maximum clearance of blood vessels
  • no activity restriction after treatments, except to limit exposure to sunlight during treatments
  • no compression stockings required, in most cases

Q. What are the side effects?

A. Most side effects are short-term:

  • reddening of skin and local swelling usually disappears in 1-2 days
  • pain generally lasts only a few hours
  • change in pigmentation or skin color may occur but usually reverses within 2-3 months