Spider Vein Treatments
As with other venous disease, a layered approach to treatment is best. If a careful history and physical exam raises concern for an underlying problem in a deeper vein, an ultrasound may be ordered to evaluate. Surface vein treatments work best if all the underlying venous reflux is treated first.
Sclerotherapy is still considered the “gold standard” treatment for spider veins. Sclerotherapy is injecting a solution into a diseased vein to “sclerose” or scar the vein shut. The solution irritates the vein, which makes the vein wall sticky. Over time, the veins seal shut and are reabsorbed by the body. The injections are done through very small needles and are relatively painless. Different concentrations of the sclerosing solution are used depending on the size of the vein being treated. A skilled vein specialist will target the reticular veins feeding the spider veins in order to improve the results of treatment.
There are a variety of solutions available for sclerotherapy. Hypertonic saline is a concentrated salt water solution. It is FDA approved, but not specifically for sclerotherapy. It works by drawing water out of the cell, dehydrating and killing it. Advantages to hypertonic saline include that it has no risk of allergic reaction and is inexpensive. Its disadvantages include that it is painful when it is injected and has a high incidence of adverse reactions such as skin discoloration, causing new spider veins to develop (telangiectatic matting) or causing ulcers if it leaks into the tissue surrounding the vein treated. Dr. Jones does not use hypertonic saline for these reasons.
Sodium Tetradecyl Sulfate (STS) is a detergent sclerosant. It works by disrupting the protein molecules in the vein cell wall. It is FDA approved for use in sclerotherapy. It is safe, reliable, and painless when injected in low concentrations. It has a much lower incidence of adverse reactions such as skin discoloration, inflammation or ulceration compared to hypertonic saline. There have been rare reports of allergic reactions to STS.
Polidocanol is a local anesthetic which is effective as a sclerosant as well. It has been widely used in Europe for sclerotherapy with good results. It was recently FDA approved for use in this country. It is painless when injected. Polidocanol, like STS, has a low incidence of adverse reactions such as skin discoloration, inflammation, or ulceration. It also carries a very small risk of allergic reaction.
Surface lasers are effective against some spider veins and small varicose veins. In the majority of scientific studies, however, sclerotherapy has been shown to be more effective than laser when performed by a skilled vein care specialist. Most people find sclerotherapy to be less painful than laser treatment of spider veins.