In our clinic, we see many people who want to make their legs look better. They have silently suffered for many years, and it still surprises me how long they wait before consulting a doctor. Very often, spider veins are the culprit. They can certainly be a nuisance, and occasionally cause pain and even bleeding. But nowadays, several minimally invasive procedures exist to relieve the problem. Let me explain in more detail.
Sometimes those spider veins are purely cosmetic and can be treated locally with sclerotherapy. A solution called a sclerosant is injected into the veins with a tiny needle. This solution irritates the lining of the vein, which, in response, collapses and is reabsorbed, causing the surface veins to no longer be visible. Depending on the size and location of the veins, different types and strengths of sclerosants are used. Thanks to this procedure, veins can be dealt with at an early stage, helping to prevent further complications down the road.
Frequently, spider veins are just the visual appearance of a deeper problem. In essence, they are an indicator of a problem with a deeper vein, where damaged valves within an upstream vein cause a back flow of blood. The back flow causes increased pressure in downstream veins, causing them to fail. This is called venous insufficiency, and should be screened for before deciding on any treatment plan. We typically screen all patients with an ultrasound, at no charge, for venous insufficiency, no matter what the complaint. Why do we do this, might you ask? We believe that in order to get the best results, you have to attack the problem at the deepest source and then work your way to the veins that are downstream. When severe reflux is demonstrated on an ultrasound and symptoms exist—typically, aching and swelling–it makes it clear to us that the issue is medical problem. The good news about this fact is that medical procedures are typically covered by insurance.
If a medical problem with a vein does exist, then it’s best to start with an endovenous ablation of the culprit vein before moving on to sclerosants. Endovenous ablation is a painless procedure during which a small laser fiber is inserted into the vein. Once inside the vein, the laser fiber pulses light and heat to shut the vein down, thereby removing the problem.
Left untreated, diseased veins can get progressively worse over time. Once symptoms develop, such as dull aching, edema, cramps, pain, or restless legs, it becomes a medical problem and it is highly advised that you see a medical specialist to diagnose the issue. Symptoms development can be slowed or halted using compression stockings, and it is recommended to use stocking for at least three months before undergoing any procedures.
By: Andrew Mapes, MD