When visible signs of venous disease such as spider veins, varicose veins, or skin changes are present, this is usually a sign that there is an underlying vein problem. An underlying vein condition (venous reflux disease) can be detected with ultrasound. Treatment plans are focused on treating the underlying vein problems first, then focusing outwards.
Step 1: Identify Underlying Problem
The first step is to treat the underlying problem, the venous reflux. The specific pattern of venous reflux is detected by ultrasound. Venous reflux usually starts in the saphenous veins. The saphenous veins are most effectively treated with vein ablation procedures. This involves placing a small catheter within the vein and using heat or a solution to produce injury and eventual closure of the vein. The most commonly used treatments for the saphenous veins are radiofrequency ablation (RFA), laser ablation, mechanochemical ablation (MOCA or Clarivein), and in some cases Varithena Foam. The treatment recommendation is customized, based on where reflux is present and other clinical factors.
Step 2: Treat The Varicose Veins
After the underlying vein reflux is corrected, the bulging veins (varicose veins) can be treated by injecting a foamed medication that will cause them to scar and eventually dissolve (foam sclerotherapy), or to remove them using tiny incisions. The most common method is foam sclerotherapy. This is also known as ultrasound-guided foam sclerotherapy (UGFS).
Step 3: Treat The Spider Veins
Spider vein treatment is always considered a cosmetic procedure. If improved cosmesis is a goal of treatment, make sure to discuss this with your doctor and plan on having cosmetic treatment as the last step. Spider vein treatment is accomplished by sclerotherapy, which is an injection of liquid medication into the spider veins. Most patients use 3 vials and have an average of 3 treatment sessions. Ask your provider for an estimate about how many treatment sessions/ vials are necessary to get the results you want.