Sclerotherapy Or Vein Laser Treatment, Which Is Better For Spider Veins ?
Written by Dallas Vein Specialists on May 7, 2011
At Dallas Vein Specialists in the course of seeing numerous patients and treating their spider veins, I am frequently asked the question, “What about LASER?” and “When do you use LASER?”. Little wonder that these questions come up so often and that patients are confused about the options for spider vein treatment, as there is so much talk about lasers.
At Dallas Vein Specialists we use special lasers to ablate, or do away with, veins that are deep to the skin and usually course deep in the fat layers of the leg. These lasers work exceedingly well and result in the eventual disappearance of the treated veins, hence the term ‘laser ablation’. But we do not use lasers that are designed for skin surface veins such as spider veins. This practice is for a very good reason, they do not work nearly so well as SCLEROTHERAPY, the treatment of veins by injection of chemical agents that result in the disappearance of the veins.
Spider veins may occur anywhere on the leg and are surface vessels, easily seen in the top layer of the skin. They are small, measuring less than 1mm in diameter, and are often numerous and frequently arranged in clusters. They may cause symptoms such as burning or aching when a person stands for a while, but the overwhelming reason most patients come in for treatment is the unsightly appearance of the spider veins.
In order to achieve the desired result of treatment, the disappearance of the spider veins, it is necessary to cause an irreversible injury to the spider vein blood vessel, after which the vessel will clot and no longer carry blood. Then the body will remove the vein over time, a feat accomplished by the body’s own inflammatory process activated on account of the injury. The length of time this process requires varies with the size of the vessel and the location of the spider vein on the leg. Most spider veins begin to fade and look much better in 2 to 3 weeks, and most are gone in 4 to 6 weeks. For larger vessels, especially ones located about the feet and ankles, it may take 2 to 3 months before the last vestige of clot is entirely gone. Of course the treated areas will look much improved long before that.
Both laser devices designed to treat at the skin surface and sclerotherapy will produce damage to spider veins. In the case of the laser the results are much less predictable than with sclerotherapy. I have seen numerous patients at Dallas Vein Specialists who have had little or no response to repeated laser treatments and who have presented with frustratingly persistent spider veins, this after having expended time and money for the treatments, which are considerably more expensive that sclerotherapy. It is not uncommon to find that patients have also suffered laser-induced skin damage resulting in an ulcer or sore that was slow to heal. They have been left with scars from such skin injuries and still have their spider veins too! With sclerotherapy skin ulceration and sores, although they may occur, are rare indeed when the proper agents are used. The agents used at Dallas Vein Specialists are safe, not painful, and do not damage the skin.
As I mentioned the laser treatments cost time and money. The application of skin lasers to spider veins is a slow process, as the treatment is done one millimeter at a time. Consider the time it would take for the laser technician to treat one cluster of spider veins. Since the patient is paying for the use of the expensive laser and the treatment time, which usually requires several sessions to treat both legs, the expense can run into the thousands of dollars. And what of the patient’s time for multiple trips to the laser clinic? Whereas with sclerotherapy we are usually able to treat both legs and most if not all spider veins during the first 30 – 40 minute appointment. A further “touch up” treatment may be necessary depending on the number of spider veins and the success of the initial treatment, but such treatments are usually shorter and at less cost than the initial one. The treatments are much faster, because only one or two injections may fill an entire cluster of spider veins with the chemical agent.
Another consideration is patient discomfort. Patients frequently speak of the unremitting pain of the laser treatment citing the repeated jolt of pain each time the laser is ‘fired’. Consider how often this would be when so many ‘firings’ are necessary just to treat one spider vein cluster. With sclerotherapy the exceedingly small needle causes only minimal discomfort if at all. The chemical solutions are not painful, as we do not use hypertonic saline, which is an effective agent but one that causes pain on injection and is caustic to the skin and may result in skin ulceration. The sclerotherapy agents used at Dallas Vein Specialists are safe, not painful, and are highly effective for most patients.
In summary, the laser treatment of spider veins is more painful, expensive, and less predictive of good result than is sclerotherapy. Sclerotherapy in the hands of an experienced vein surgeon is highly effective and safe and requires less time and expense to achieve the treatment goal of resolution of the spider veins.