Sclerotherapy is the best treatment available for spider veins and reticular veins (remember these are the blue-green ones that run just underneath the surface of the skin, sometimes called feeder veins). It requires a high level of expertise, especially for the smaller veins, but it is extremely safe when performed by a specialist in Phlebology.
It is a performed in staged short office visits, usually no more than 15-30 minutes. The patient can immediately resume their normal activity, including exercise. It requires no anesthesia and no post-treatment care, although some patients may be advised to wear compression hose for a week following treatment to enhance their results and reduce nuisance side effects.
Laser Treatment for Spider Veins
Some laser companies have claimed outstanding results with laser treatment for spider and reticular veins. This is far from real case results achieved in true practice. In truth, laser treatment is the only safe and effective treatment for hemangiomas, and for very small facial spider veins, and for a select group of leg spider veins.
The majority of spider and reticular veins on the lower extremities will not respond well to the current lasers available on the market. The technology is not at the point where laser is a great tool for treating these veins, especially in the hands of most doctors that are dabbling in treating veins and not extensively trained as Phlebologist. However, as an exception in the hands of a very select few national experts in the world, many of whom are in the U.S., laser can be an effective tool in treating leg spider and reticular vein.
I see several patients every week who have either wasted a lot of time and money on laser treatment and obtained very poor to no results; or worse, have gotten skin burns and scars that no one can treat now. Be very careful when selecting your doctor for treatment. Ask a lot of questions and look at pictures of the doctor's work. Remember, you can only judge an architect by the house he builds.
Ultrasound Guided sclerotherapy
Ultrasound Guided compression sclerotherapy is a great alternative to surgical stripping in the treatment of most varicose veins. If major truncal veins such as the GSV (Greater Saphenous Vein) or SSV (Short Saphenous Vein) are not involved, double blind, controlled, prospective studies have shown equivalent results as surgical stripping 95% of the time. But without the inherent risks of surgery like bleeding, scarring, DVT (deep venous thrombosis or blood clots), and infection.
It differs from surgical stripping in that no general, local, or regional anesthesia is required so there is none of the risk of anesthesia either. There is no hospitalization and there is no time needed for recovery. As an office procedure, it permits the patient to resume regular activities the same day. It does require a high degree of technical competence, but when correctly performed it gives excellent results and is a very cost effective procedure. The number of therapeutic sessions required depends on the severity of venous disease and upon the individual patient's response to the medications used.
The largest caliber vein(s), such as the greater saphenous, lesser saphenous, and major perforators, are cannulated with 27 gauge butterflies, and 3 to 5 ml of sclerosant is slowly infused using an empty vein technique. The most commonly used sclerosants are Sotradecol (0.4% to 3%) or Aethoxysclerol (0.5% to 5%). All other varicosities are treated using 1cc tuberculin syringes and 30 gauge needles to infuse 0.05cc to 1cc of sclerosant at each site intraluminally. Cotton balls or rope are secured, and a previously fitted 30-40 mm Hg gradient elastic stocking is placed. The surgical compression stocking is worn continuously for a period of time appropriate to the patient's problem.
Residual and incompletely resolved varicosities, along with varicosities not treated in the first session, are cannulated and perfused with sclerosant as described above. Continuous compression is reapplied as before.