Varicose Veins and Spider Veins

What are Varicose Veins?

The saphenous vein is the major superficial vein of the leg that runs along the inner part of the leg from the ankle to the groin.  In many people, the one-way valves in the saphenous vein become incompetent.  This leads to increased pressure in the superficial venous system causing vein branches to dilate.  These dilated, rope-like veins are called varicose veins.  They are often one-fourth inch or larger in diameter.  These blue, bulging veins lie just beneath the skin.

What are Spider Veins?

Spider veins are tiny veins that are either blue or red in color and are closer to the skin surface than varicose veins.  They often look like tree branches or spider webs and are often unsightly to the patient.

Do Varicose/Spider Veins Cause Symptoms?

Moderate to large varicose veins often cause an aching or burning discomfort particularly after periods of standing.  Sometimes blood clots form within the varicose veins, a condition called thrombophlebitis.  This causes more significant pain, and swelling can occur.  As varicose veins become more severe, hardness of the skin can occur from scarring and often a dark pigment stains the skin.  On occasion, ulcers can form in the lower legs.  Less commonly, a varicose vein may erode the skin resulting in bleeding.  Some patient’s develop a rash that causes itching which can be quite bothersome.

What Treatment is Available for Varicose Veins?

In some patients, support stockings or compression hose are beneficial at controlling symptoms of varicose veins.  In warmer climates, however, patients have a difficult time wearing compression hose on a daily basis. Surgical therapy for varicose veins has been performed for many years.  Because varicose veins are usually caused by incompetent valves in the saphenous veins, saphenous vein “stripping” was the surgical procedure of choice for many years.  The failure rate of this procedure is as high as 20% in many series resulting in recurrent varicose veins.  As the name implies, vein “stripping” is a traumatic procedure that results in significant scarring, bruising, and postoperative pain.

In recent years, techniques have been developed to close the saphenous vein to avoid “stripping.”  This new treatment is called endovenous ablation of the saphenous vein, and the most successful technology involves the use of laser energy.  This new treatment of endovenous saphenous vein ablation coupled with removal of the varicose veins through tiny puncture wounds (micro-phlebectomy) or by injection with new solutions (sclerotherapy) has been a remarkable advancement in treatment of superficial venous disease.  Varicose vein disease can be treated without making a surgical incision!

How are Spider Veins Treated?

Spider veins are best treated with injections of solutions that obliterate the lumen of the vein.  The spider veins are accessed with a tiny needle and two new solutions, foamed Sotradecol and glycerin, are injected.  These new solutions have resulted in much improvement in spider vein treatment with fewer skin complications.  Although laser was initially touted as a treatment for spiders, sclerotherapy has yielded much better results.

What are the Advantages of the New Procedure?

Endovenous saphenous vein ablation using the laser is a less traumatic procedure than vein stripping, resulting in less pain and bruising.  Using the micro-phlebectomy technique to remove the varicose veins utilizes tiny stab wounds, minimizing scarring.  Patients often return to work in two or three days.

Are the Procedures Painful?

Endovenous saphenous vein laser ablation is performed using local anesthesia and intravenous sedation.  Most patients experience minimal pain during the procedure.  Postoperative discomfort is often controlled with non-narcotic medication and rarely lasts longer than one to two weeks.

What are the Risks of the Procedures?

Does Insurance Cover the Treatments?

Almost all insurance companies (including Medicare) cover laser endovenous ablation of the saphenous vein.  Often, predeterminiation by the insurance companies is required.  Spider vein treatments are considered cosmetic procedures and are rarely covered.  The consultation and venous ultrasound are usually covered by insurance.