Veins Guide

Vein Treatment Techniques

Leg affected with spider veins

Venous insufficiency is the most common disorder of the venous system. It usually manifests itself with the appearance of spider veins or varicose veins. There are different vein treatments used today depending on the type of vein, its pattern as well as the vein specialist’s preferences.

Following a comprehensive evaluation which includes an ultra-sound examination of the veins, the vein specialist will determine what type of problematic veins you have and the  best treatment to eliminate them. Treatments are classified as either surgical or non-surgical. Surgical vein treatments include sclerotherapy, foam sclerotherapy, ambulatory phlebectomy, ligation and stripping, radiofrequency ablation and traditional vein lasers. Non-surgical treatment techniques include the use of creams, lotions and compression stockings.

The goal of the different vein treatment techniques is to remove or reduce the size of diseased or damaged veins that can cause pain or are clearly noticeable on the skin’s surface. There are different vein treatments and some are better suited for treating specific areas of the body. It is important to know which type of vein problem you have, do some research, determine your options and discuss them with your vein doctor. Every vein specialist has his/her own vein treatment preferences. In addition, there are vein treatments that are used only for varicose veins while others are better suited for treating spider veins.


Sclerotherapy is a medical procedure used for the removal of spider veins and smaller varicose veins. During the procedure, a needle is used to inject a sterile chemical sclerant into the diseased veins. The sclerosing solution contains hypertonic saline, polidocanol and sodium tetradecyl sulphate. The vein doctor will inject the sclerant in the large veins first and then the smaller ones will follow.

The sclerant targets the lining of the vein, irritating it and causing it to shrink and gradually fade away. Blood circulation in the treated area is passed to other healthy veins located near the troubled vein but deeper within the body. This reduces the outward appearance and the pain associated with the problem vein.

Sclerotherapy works well for majority of patients and they find it relatively painless. Some patients feel a stinging sensation when the doctor is making the injections. However, the pain and discomfort depends on the pain tolerance level of the patient. The procedure does not require any anesthesia but if you feel a bit of pain during the treatment session, your vein doctor can apply topical anesthesia. The whole sclerotherapy procedure takes 15 to 30 minutes. A bandage will be applied over the area that received the injections and you may have to wear compression stockings for a few days.

Foam Vein Sclerotherapy

Foam sclerotherapy is a technique that helps eliminate varicose veins and smaller spider veins. It uses a medication that produces foam or micro-bubbles before it is injected into the skin. The chemicals in the foam are carbon dioxide and sodium tetradecyl sulfate. These chemicals cause scar formation on the vessel walls, causing them to harden, collapse and get absorbed by the body.

There are two distinct advantages of foam sclerotherapy over traditional sclerotherapy techniques. The foam can displace the blood in the vein being treated, so the sclerosing formula gets in direct contact with the vein wall for a longer period of time. This enables the foam to work more effectively as compared to liquid agents which can be easily diluted by blood. Moreover, the foam is visible on ultrasound, and its location, movement and effects can be guided and monitored more effectively by the doctor.

The procedure starts with the application of a topical anesthetic on the area to be treated. Once the area is already numb, the vein doctor will inject the sclerosing foam, using ultrasound to make sure that it spreads evenly across the treatment area. Depending on the size of the treatment zone, more than one injection may be needed. Most treatment sessions take about 30 to 45 minutes to complete.

Ambulatory Vein Phlebectomy

Ambulatory phlebectomy is a vein removal technique, particularly varicose veins in the legs. The procedure can be performed in the vein doctor's office or clinic. The treatment starts with the injection of local anesthesia to numb the target area. The doctor then makes small incisions on top of the affected vein and extracts it with the help of a phlebectomy hook. The incisions are very small so no stitches are needed. Since veins are highly collapsible vessels, even large veins can be extracted through the incisions.

After treatment, the doctor will apply compression bandage on the leg to aid the healing process. The vein doctor may also ask you to wear a compression stocking but this will depend on the size and degree of damage to the vein that was removed. You will be able to walk after the procedure, in fact many doctors recommend that patients walk around or bike to reduce pressure in the veins, increase blood flow and reduce the risk of developing a blood clot.

Transilluminated Powered Vein Phlebectomy

Woman with vein problems in her legs

Transilluminated Powered Phlebectomy (TPP) is a minimally invasive treatment procedure used for the removal of varicose veins. It uses a canulla illuminator that works pretty much like a flashlight. It is inserted into the skin through a small incision made by the surgeon. The light allows the surgeon to see and accurately remove varicose veins. The procedure has to be performed in a surgery room under a light anesthetic. The room is dark as the procedure progresses so the surgeon can see the illuminator under the skin.

Tumescent fluid is infused under the skin to loosen the vein from adjacent tissues while providing local anesthesia. Another instrument, called a vein remover, is inserted in a separate incision and then guided to the varicose veins. The veins are suctioned into a hole at the tip of the vein remover and a blade cuts the vein into segments that can be easily suctioned out of the body.

The entire TPP procedure can be performed in 30 minutes, and since only tiny incisions are made, there is no need for stitches. Most patients wake up without any pain and allowed to go home after about an hour. Routine activities are encouraged immediately and majority of patients return to work in 2 to 3 days.

Vein Ligation and Stripping

Vein ligation and stripping is a minor surgical procedure used for treating varicose veins. During vein ligation, the surgeon makes incisions over the problem vein and ties it off. In a vast majority of cases, the vein involved is the saphenous vein. If it still has some healthy valves, only the weak or damaged section is closed off by ligation. This is done to cut off the blood flow through to the varicose vein so it becomes less visible.

If the entire vein is compromised, the vein may have to be stripped altogether. Two small incisions will be made at the ankle and groin and a number of micro-incisions along the affected branches of the veins on the leg. Next, the surgeon will tie off the varicose veins connected to the saphenous vein then removes it from the leg. Stripping the saphenous vein reduces the pressure caused by the back flow of blood through this large vein as well as the smaller veins that feed into it.

This surgery is performed as an outpatient procedure under general anesthesia. However, there is no need to stay overnight at the hospital since you will be allowed to go home 2 hours after the surgery. Vein ligation and stripping is safe and is not as painful as it sounds. In fact about 150,000 of such surgeries are performed annually in the United States.

Vein Electrodessication

As the name suggests, electrodessication is a technique for removing veins with the help of an electric current. The procedure involves the use of a fine needle that is inserted superficially into the skin. When the needle comes in contact with the veins, a monopolar high-frequency current is activated. The ‘electric shock’ causes the vein to swell and later collapse, sealing off the flow of blood.

Electrodessication can be used for treating veins on the face and legs. The treatment is better suited for spider veins, although it can help with varicose veins as well. The procedure may leave some scars, but the removal of the spider veins will be worth it.

Surface Laser Vein Treatment

Laser vein treatment is an effective way of eliminating unsightly vessels and vascular lesions like varicose veins, spider veins, port wine stains, rosacea, among others. This form of treatment has become even more effective, safer and faster, thanks to the advances in laser technology. It is also a less invasive alternative to vein stripping and other surgical vein removal techniques.

The laser works by emitting strong bursts of light that is passed through the skin and onto the target vein. This makes the vein break up, gradually fade and disappear. However, lasers cannot treat all skin types and colors, so consult your doctor regarding this issue. No incisions and needles are used, although the heat generated by the laser can be a bit painful to some patients. For this reason, vein doctors apply a topical anesthetic to numb the area before treatment. Some simply use cool compresses for any pain or discomfort felt during the procedure.

Laser vein treatments last for about 15 to 20 minutes. In most cases, 2 to 5 treatment sessions are required to remove spider veins in the legs. Laser treatment is usually not effective for varicose veins that are larger than 3 mm. Sclerotherapy will be more effective in such cases. Even larger veins are treated using ambulatory phlebectomy. Your vein doctor will evaluate your situation and determine which treatment technique will give you the best results. After a laser vein treatment, there is no downtime so you can immediately return to normal activities.

Endovenous Laser Treatment

Endovenous laser treatment (ELT) is an ultrasound-guided technique used for treating incompetent truncal varicose veins such as the great saphenous vein and small saphenous vein. EVLT (Endovenous Laser Treatment) is the same as ELT but it is a trade name owned by Diomed. EVLT is used as the term for Diomed’s 910nm laser treatment equipment for ELT. The 810nm laser is actually the original laser fiber wavelength, but over time, different fibers with different wavelengths have been introduced into the market. Each of the wavelengths aims to maximize damage to a part of the varicose vein or the blood it contains while minimizing damage to surrounding tissues.

During the procedure, a catheter containing a laser probe is inserted under ultrasound guidance through a tiny incision in the skin and then into the vein to be treated. Local anesthesia is injected along and around the vein, usually in a sub-facial location, using ultrasound imaging. The doctor then activates the laser while withdrawing the catheter, causing constriction and closure of the vein along its entire length. Permanent ablation of the affected vessel is caused by thermal damage to the entire circumference of the vein.

The procedure typically takes between 1 and 2 hours. A bandage is applied to the leg and/or the patient is instructed to wear a stocking for up to 3 weeks after treatment. There is no post-operative scarring and the patient can immediately return to normal activities.

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