Treatment

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Because varicose and spider veins are congested with blood, they really aren't doing their job any more. Fortunately, there are usually plenty of other, healthy veins to take over. So most of these unwanted veins simply aren't necessary and can be removed. But while invasive treatment is an option, don't rush to the operating room. There are simpler things you can try first, including:

• walking regularly, which helps improve muscle tone and circulation, and reduce your body weight

• finding several times during the day when you can elevate your legs for 10 to 15 minutes

• wearing compression hose or stockings, which can be purchased at most pharmacies; they help your leg muscles push blood upward by concentrating pressure near the ankles; specially manufactured gradient-compression support stockings are the most effective for controlling symptoms; they may also prevent worsening of the condition and avoid the need for any future treatment

• taking an over-the-counter anti-inflammatory drug such as aspirin or ibuprofen to alleviate occasional swelling and pain

If these conservative methods don't work to your satisfaction, you should discuss with your health care professional the possibility of trying one or more corrective measures, such as:

• Sclerotherapy can be used to treat both varicose and spider veins. The procedure is performed in a health care professional's office and only causes minimal discomfort. A tiny needle is used to inject the veins with sclerosing (hardening) solution, which irritates the lining of the vein. In response, the vein collapses and is reabsorbed. You may need one or several sclerotherapy session four to six weeks apart, and may have one or several injections per session. Complications may include:

  • development of groups of fine, red blood vessels near the injection sites of larger vessels on the thighs, some of which disappear on their own and others of which require treatment

  • muscle cramps, which go away in 10 to 15 minutes

  • red bumps at the sites of the injections, which fade within a few days.

  • bruising, which usually fades after a week or two

  • or pigmentation (brown lines or spots) which can last for several months and is sometimes permanent

  • or, occasionally, phlebitis (blood clots) when larger varicose veins are treated

In addition, if you develop small painful ulcers at the injection site, inform your health care professional immediately. According to the American Academy of Dermatology, while fading is gradual, most patients can expect a 50 percent to 90 percent improvement with sclerotherapy.

• Duplex-guided sclerotherapy is sclerotherapy done while your health care professional visually monitors the vein on an ultrasound screen. This process enables treatment of veins that can't be seen because they are further beneath the skin.

• Laser/light source treatments are generally used to treat spider veins or very small varicose veins and may be combined with sclerotherapy. A laser or light beam is pulsed onto the veins to seal them off and cause them to dissolve. Multiple treatments are usually required. According to the American Academy of Dermatology, leg vessels don't respond uniformly to laser treatment, which is more effective on facial spider veins.

• Electrodesiccation is a technique that utilizes an electrical current to seal off damaged veins. The treatment, however, may leave scars.

• Radio frequency occlusion (also called the Closure® procedure) or laser-induced occlusion (EVLT) is an outpatient alternative to surgical stripping of the main surface vein, called the greater saphenous vein. Usually done in a health care professional's office under local anesthesia, a small catheter is inserted into the damaged vein and delivers either radiofrequency energy or laser energy to the vein wall, causing it to heat. As it warms, it collapses and seals shut.

Surgery

Surgery is generally used to treat large varicose veins and can be performed using local, spinal, or general anesthesia. Most patients return home the same day as the procedure. Surgical options include:

• ligation, or tying off of a vein

• stripping, or removal of a long segment of vein by pulling it out with a special instrument

• ambulatory phlebectomy, or removal of veins through a series of tiny incisions; often done in an office under local anesthesia

Unfortunately, no treatment can prevent new veins from becoming varicose. Varicose veins sometimes recur after any form of treatment, but it's not the same vein coming back; it's a new vein becoming affected.

Before undergoing any sort of procedure for varicose or spider veins, be sure to tell your health care professional if you've ever had blood clots in your lungs or legs.

Health care professionals who specialize in the treatment of varicose veins include:

• general surgeons, physicians with a specialty in performing surgery

• vascular surgeons, physicians with a specialty in treating blood vessels

• dermatologists, who specialize in the diseases of the skin

• phlebologists, who specialize in the field of medicine that deals with vein diseases. However, "phlebology" is not a recognized specialty with formal training, accreditation and certification procedures.

Unfortunately, some treatment centers specializing in varicose veins have been caught by the Federal Trade Commission making unfair promises to patients. Keep in mind that no treatment for varicose veins is ever 100 percent effective, nor is there ever a 100 percent guarantee that other veins in your legs won't become varicose.

Some companies distribute herbs or over-the-counter diet supplements with claims they prevent or cure varicose veins. While some of these supplements claim to have been shown in testing to improve circulation or impact veins in other ways, keep in mind that herbs and supplements are not regulated and there is no guarantee of quality, safety or efficacy. Also remember that there is no 100 percent cure for or prevention of varicose veins.

You should know that the less invasive treatments often end up costing more than surgical treatments. This is particularly true when more expensive treatments such as laser and radio frequency ablation are used. While there are some advantages to these techniques, they have a shorter track record than other forms of treatment, although recent comparative studies demonstrate the efficacy of closure to be equal or superior to that of surgery. It's important to discuss cost of treatments and out of pocket expenses up front because your health insurance may not cover the cost of the procedure.