What procedures are available to treat varicose and spider veins?
Varicose veins are frequently treated by eliminating the "bad" veins. This forces the blood to flow through the remaining healthy veins. Various methods can be used to eliminate the problem veins, including, most commonly, surgery to close them down or remove them, or sclerotherapy (injection of irritating substances into the problem vein to irritate the vein lining and close them down). Less commonly, laser or electro-cautery treatments have been used to treat the smallest spider veins, especially on the face. Surgery to treat varicose veins, commonly referred to as "stripping," is usually done under local or partial anesthesia, such as an epidural.
Here, the problematic veins are "stripped" out by passing a flexible device through the vein and removing it through an incision near the groin. Smaller tributaries of these veins also are stripped with this device or removed through a series of small incisions. Those veins that connect to the deeper veins are then tied off. This stripping method has been used since the 1950s.
Spider veins cannot be removed through surgery. Sometimes, they disappear when the larger varicose veins feeding the spider veins are removed. Remaining spider veins also can be treated with sclerotherapy. Sclerotherapy uses a fine needle to inject a solution directly into the vein. This solution irritates the lining of the vein, causing it to swell and the blood to clot. The vein turns into scar tissue that fades from view. Some doctors treat both varicose and spider veins with sclerotherapy. Today, the substances most commonly used in the U.S. are hypertonic saline, sodium tetradecyl sulfate (Sotradecol) and aethoxysklerol/Asclera (Polidocanal).
During sclerotherapy, after the solution is injected, the vein's surrounding tissue is generally wrapped in compression bandages for several days, causing the vein walls to stick together. Patients whose legs have been treated are put on walking regimens, which forces the blood to flow into other veins and prevents blood clots. This method and variations of it have been used since the 1920s. In most cases, more than one treatment session will be required.