Vein Therapy FAQs by Dr. Wright

I have some spider veins and some thicker veins that are not bumpy but are painful. From what I have read, laser treats spider veins but not the bumpy ones. Am I right?

A: There are two types laser therapy when it comes to leg veins. The first, an external laser, can be passed over areas showing spider veins. External lasers for leg veins don’t have a great success rate. The best treatment for superficial unsightly spider veins is sclerotherapy, done by an expert.

The second type of laser is endovenous laser treatment. This treats enlarged varicose veins. A laser is inserted, destroying the varicose vein by delivering high temperature to the inner lining of the varicose vein. Anesthesia makes this comfortable. Endovenous laser ablation has been FDA approved only for treatment of one type of varicose vein, the Greater/Long
 Saphenous Vein. This treatment is safer when it is used for the thigh segment of that vein. Lower and side branches are best treated with hook-phlebectomy, or even better, using foam sclerotherapy. Some doctors use EVLT for treatment of short saphenous vein (the superficial vein behind
the calf). This treatment is not FDA-approved for short saphenous treatment. Foam sclerotherapy is a great choice for treatment of short saphenous varicosity when performed by an expert phlebologist.

I had 3 laser surgeries done on my leg in 2006. It helped with pain and swelling I’d been experiencing. Right now I have superficial phlebitis in that leg.

Should I have more treatment?

A: There is no specific limit to the number of endovenous laser procedures that can be performed on one leg. However, successful EVLT requires certain conditions. These include a length of vein that is straight enough to pass the laser catheter through.

I have some spider “purple” little veins in the penis can those veins be treated with VeinWave or other treatments?



A: Purple veins on the penis are not abnormal. I would not recommend treating them with VeinWave.

Is there a limit to the size of vein that VeinWave treats?



A: Yes , VeinWave is only effective on small red veins. It does not have a good result on veins that are blue or purple.

Can you please tell me if this laser vein treatment is painful or not?



A: Endovenous Laser treatment is not very painful. It can be mildly uncomfortable for people.

Cutaneous Laser and IPL are a little more uncomfortable, like grease popping on skin. However, most people tolerate it well.

I’m not sure what I need, what would you recommend for veins that are showing up in my cheeks?

A: The old standby is the Lyra or KTP laser. It can take several treatments, but it hurts. Veinwave, which uses radio waves, works as well or better and is more comfortable. IPL, Intense Pulsed Light, can help for veins but only on the smallest veins. IPL also can help with skin pigment.

I have a small blue vein under my eye. It is becoming more noticeable. Can VeinWave safely remove this vein?



A: Bluish veins are usually too large to be treated effectively with a VeinWave
, but I can’t be sure without seeing it.

Will VeinWave treat varicose veins?

A: No, the VeinWave can not treat veins the size of varicose veins.

Do compression stockings help with Hemosiderosis and Venous Insufficiency?



A: Stockings do help with venous insufficiency. They can potentially help with hemosiderin “staining.” They will not treat underlying hemosiderosis, the excess iron in the blood.

Are there any complications such as skin wounds after Sclerotherapy?



A: Numerous adverse sequelae may arise after sclerotherapy. Some of these include hyperpigmentation due to iron deposits, temporary swelling, telangiectatic matting (fine, red spider veins that develop in a treated area), localized redness (known as urticaria), cutaneous necrosis and allergic reactions. Most of these resolve with minimal treatment; some can be permanent in a small number of cases.

Can Endovenous Laser Ablation be used on a Vulvar Vericosity?



A: Vulvar varicosities, as all varicosities, require an accurate venous duplex examination. This frequently pinpoints the source of varicosities. Frequently, these arise as refluxing veins around the origin of the saphenous vein and can easily be treated with Sclerotherapy, but not with Endovenous Laser Ablation.

I have mosquito-ish marks where, I guess, the VeinWave machine did the capillary veins. When will these go away so I don’t have to put makeup on?

A: Mosquito-like marks are usually gone in a day or two. With very fair skinned individuals, these marks could last a week.

Will sclerotherapy stop restless legs? Is it possible I will be able to do without medication for restless legs?

A: There is a strong correlation between restless legs and venous insufficiency. If ultrasound reveals venous insufficiency and it’s treated, there is a strong chance that you will experience improvement. If you are having sclerotherapy for spider veins only, it’s doubtful this symptom will go away. Spider veins can cause restless leg symptoms. I recommend that you ask your vein doctor whether you have any venous insufficiency.

I had endovenous laser ablation and foam sclerotherapy but new veins kept appearing in my leg. I suffered from phlebitis in this leg following surgery and it has never felt the same since. It aches and feels heavy. I have new veins in my upper thigh and calf.

A: It depends on how long ago you had the procedure and how many treatments of foam you were given. The phlebitis you experienced would have been a result of the foam sclerotherapy.
In our practice, we tend to hold off on foam sclerotherapy until about 6 – 8 weeks or longer after the ablation.

Some people will develop small spider-type veins in response to the ablation. These are called “matting.” If there are scattered isolated veins appearing, they may have appeared anyway. You may be more focused on your legs since the procedure and noticing veins you already had.
If you have the symptoms you mention, you should have an ultrasound examination to determine if the treated veins are sealed. In experienced hands, this shouldn’t occur.