Frequently Asked Questions

Q. What symptoms and complications can occur if varicose veins are left untreated?
A. Symptoms include leg tiredness, heaviness, aching, throbbing, restlessness, tingling, burning, itching, numbness and swelling. Complications such as phlebitis, blood clots, dermatitis, bleeding and stubborn open sores (ulcers), can occur if veins are left untreated.

Q. What is sclerotherapy?
A. Sclerotherapy is the injection of small amounts of a special solution directly into unwanted veins. When performed properly. This collapses and shrinks the treated veins, which are later reabsorbed by the body’s natural healing response. It is a brief office procedure that requires no anesthesia.

Q. What is the success rate for sclerotherapy?
A. In expert hands, close to 90%. Like other technical procedures, more practice leads to improved results with fewer complications.

Q. What if a vein is needed later for by-pass surgery?
A. There are many other arm and leg veins available for donor grafts. Surgeons use these healthy veins for by-pass surgery instead of a diseased varicose vein.

Q. Don’t we need all the veins we were born with?
A. Not in the legs. For every visible vein on your leg, there are many more under the skin. By sealing off the few abnormal veins from the many normal ones, the circulation is repaired and normalized.

Q. What about lasers for vein treatment?
A. Treatment of leg spider veins by laser provides inconsistent unpredictable results that disappoint most patients. While effective for tiny cosmetic facial veins, lasers are significantly less effective on leg spider veins compared to expert sclerotherapy. However, use of newer endovenous lasers to treat the source of large varicose veins has proven to be the most effective treatment available (see below VNUS Closure).

Q. Is sclerotherapy painful?
A. Because we use very small needles (30g), and because the solution we use does not cause intense burning like hypertonic saline, there is only minor discomfort. No anesthesia is required.

Q. Is sclerotherapy safe for anyone?
A. The contraindications for sclerotherapy include: pregnancy, non-ambulatory status, allergy to the sclerosing agent, pre-existing blood clotting tendencies, and the inability or unwillingness to follow instructions.

Q. What are the instructions following sclerotherapy?
A. After sclerotherapy, the patient is advised to do non-impact aerobic activities, like walking, alternating with leg elevation and wearing compression stockings. This is for only 1 to 2 days after spider vein treatment, and for 1 – 4 days following ultrasound-guided sclerotherapy.

Q. What is the recuperative period?
A. Typically 2 - 3 days to return to normal activities.

Q. How is ultrasound used to treat veins?
A. Duplex ultrasound imaging has emerged as the best way to locate the hidden diseased veins that flood the more obvious varicose veins on the skin surface; it also provides guidance for the precise injection and laser treatment of these abnormal veins, which otherwise would have to be surgically removed.

Q. Don't some doctors treat just the bulging surface veins?
A. The older approach of treating just the visible surface veins is like trimming the leaves off a diseased branch instead of removing the branch. The leaves (veins in this case) will grow back, which is why this older method has been discarded by knowledgeable vein experts.

Q. What about the new ultrasound-guided catheter-directed procedures?
A. More recently, catheters conducting laser or radio-frequency energy may be threaded into the deeper hidden diseased (saphenous) veins to shrink them. These procedures have the highest success rate (>95%) of any treatment method including surgery. We are therefore happy to offer this second non-surgical option to treat large varicose veins in those patients proven to be qualified candidates by duplex at consultation. More information is available at the VNUS Closure website and at the BioLitec website.

Q. If sclerotherapy didn't work for me in the past, does that mean it never will?
A. No. We must first eliminate the underlying diseased veins that feed the bulging surface veins to obtain a durable result. This can be done by surgical removal, duplex-guided injection, or duplex-guided radio frequency ablation.

Q. Does this also apply to spider veins?
A. In most cases, yes. However, for spider veins, the "feeding" veins are not deep. They are visible as larger, blue-green veins on the surface, similar to normal veins often visible along the arm. Many doctors performing sclerotherapy as a sideline either ignore or avoid treating these feeder leg veins.

Q. Do you use saline for injection?
A. No. Although effective for small spider veins, concentrated salt (saline) solutions are very painful. Most phlebologists (vein specialists) use other proven solutions that cause very little discomfort and work well for different size veins.

Q. Does treatment "cure" large varicose veins?
A. Because previously normal leg veins can deteriorate over time, it is important to understand that varicose vein disease is a treatable, but incurable chronic condition. Accurate identification and elimination of all problem veins is the key to both initial control and subsequent periodic maintenance. When duplex ultrasound is used for pre-treatment mapping, the results of the best surgeons and best sclerotherapists will be similar. We therefore advise that the method a patient chooses (surgery, sclerotherapy, or endovenous laser) is less important than their choice of an experienced clinician who is expert in his/her method(s) of choice.

Q. Should a woman wait to treat her varicose veins until after all planned pregnancies?
A. That would make as much sense as postponing treatment for diabetes or hypertension due to pregnancy. Treating any of these incurable chronic conditions, including varicose veins, serves to gain control of the condition, thereby limiting damage to the target organs from the normal physiologic stresses of pregnancy. Most phlebologists agree that treatment for varicose veins is best done before or between pregnancies. Just ask any woman who has suffered through pregnancy with painful varicose veins!

Q. What about unsightly veins on the face, hands, or breasts?
A. Salem Vein Center’s experienced phlebologists can successfully treat most cases of unwanted prominent veins on the face, hands, and breasts. Laser is sometimes used in combination with sclerotherapy to treat the very fine red facial veins.