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Spider Vein Treatment: Best Practices

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima Vein Care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

In the last blog I started to write about the sclerotherapy of spider veins. I emphasized that this should be done only after any underlying abnormalities of the main trunks and branches of the superficial vein system had been treated appropriately. Once that is done, then spider vein treatment can be done with the expectation of success.

There are some people who have had spider vein treatment and have been disappointed. In many cases, this is due to underlying valvular incompetence that has not been found or has not been treated properly or thoroughly first. There is, however, another reason for disappointment. That is due to unrealistic expectations.

You should be aware that first of all, the sclerotherapy of spider veins, even if done perfectly, takes time to work. How much time? Sometimes several months. It often takes repeated treatments. Even if all of the underlying problems have been addressed, some of the spider veins will have to be injected with sclerosent more than once, and most spider veins will not be ablated completely with one injection. Some branches will be ablated, and others will not be. Sometimes a stronger concentration will have to be tried, but this must me done with caution to avoid the problem of staining of the skin.

Some really tiny spider veins may be too tiny to inject. Often, by looking carefully with the right kind of light, a larger feeding vein can be found that can be injected and that will ablate the tiny veins. But not always, and some of the really tiny spider veins cannot be treated by injection sclerotherapy.

Some vein practices employ lasers to treat veins like this. Optima Vein Care does not have lasers. There is a use for lasers, but in my opinion, the appropriate use of lasers to treat spider veins is very limited. Different wavelengths of laser light must be used for different colored spider veins, one type of laser is not useful for all colors of veins and all colors of skin. So a practice that treats spider veins with lasers must have several lasers, and each laser is expensive to purchase and to maintain. Therefore, laser treatment of spider veins is expensive. The spot size of the laser is often one or two millimeters in diameter, so a single burst of the laser will only ablate a millimeter or two of spider vein. And, finally, treating spider veins with a laser hurts. A lot. So most people can tolerate only a short burst.

If you have some really tiny spider veins, it is worth looking to find if there is a larger vein that leads to these spider veins. If so, then injection sclerotherapy may still work. These veins are termed: “reticular veins”. We have a special light that can show these veins and sometimes, injection of these reticular veins can obliterate the tiny spider veins nearby that would otherwise be too small to inject. However, finding a reticular vein is not always possible, so some tiny spider veins may not be treatable.

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