When to Choose Sclerotherapy vs. Laser Vein Therapy

If you suffer from either varicose veins or spider veins, you may be wondering whether to opt for sclerotherapy or laser therapy. Every patient has different needs, and one treatment may be better for you than the other. While this article provides a general overview, no two vein patients are alike, always discuss your options with your vein specialist.

Treatment of spider veins

Sclerotherapy and laser and light treatments are all effective treatments for spider veins as well as small varicose veins. There are advantages to each.

Sclerotherapy for spider veins

Sclerotherapy is a non-surgical treatment in which your doctor injects a chemical, called a sclerosant (irritant) into a vein, causing it to collapse and dry out. It eventually gets reabsorbed by the body and disappears. Traditional sclerotherapy using a liquid sclerosant is most effective on spider veins or smaller varicose veins, especially on the hands and legs. It is sometimes used as an adjunct to other vein treatments. For medium to larger veins, a thicker, foamy substance is used instead.

Surface laser and light treatments for spider veins

Laser and intense pulsed light (IPL) treatments are non-invasive, chemical-free treatments that involve directing light at the veins from outside the skin.

IPL or surface laser treatments are usually performed in the doctor's office and typically take anywhere from about 15 to 20 minutes, depending on the extent of the area to be treated.

You can generally return to normal activities within — at most — a day. The most common side effect is a temporary purple skin pigmentation that looks like bruising. And one study showed that a particular kind of laser (a potassium-titanyl phosphate, or KTP, laser) produced almost no bruising at all (just a single case out of 647), and most of the treatments were performed on the patients' face. There can also be some temporary redness, swelling or blistering.

Sclerotherapy advantages

Sclerotherapy is often the best choice for the treatment of superficial spider veins on the legs and hands because it's less expensive, faster and more effective than laser treatment. (In one study, sclerotherapy was 50 to 70 percent effective on spider veins versus 30 to 40 percent effectiveness for surface laser treatment.

It's also better for people with:

  • Low pain thresholds (because sclerotherapy is generally less painful than surface laser therapy)
  • Darker skin (because some types of lasers produce light at wavelengths that can cause discoloration in people with darker or tanned skin)

Laser treatment advantages

Also, although surface laser treatment of spider veins is more expensive, possibly a bit less effective than sclerotherapy, and perceived as more painful, it's still a better choice for:

  • Spider veins on the face (In the hands of a skilled physician, laser treatments are considered to be the optimal way of treating spider veins on the face.)
  • People with a fear of needles
  • People allergic to the chemical used in sclerotherapy
  • Treatment of areas with patches made up of many tiny blood vessels (known as telangiectatic matting)
  • Treatment of certain other kinds of spider veins too small to be injected

Treatment of varicose veins

Varicose veins respond well to both foam sclerotherapy and endovenous ablation.

Sclerotherapy for varicose veins

Medium to larger varicose veins are usually injected with a foam that can fill the space better and for a longer period of time than a liquid can. When doing foam sclerotherapy, the doctor often guides the needle using ultrasound imaging, particularly if the vein to be treated isn't completely visible from the surface of the skin. More than one treatment may be needed, and you will likely have to wear compression stockings for at least several days after the procedure.

Sclerotherapy side effects

The potential side effects of sclerotherapy include:

  • Skin discoloration (hyperpigmentation, a darkening of the skin color) — occurs a little less than one-third of the time, and usually goes away on its own within a few months
  • Itching, burning and pain at the site (usually goes away within a few days or less)
  • Bruising
  • Allergic reaction to the sclerosant
  • Patches made up of many tiny blood vessels (telangiectatic matting) can form if the injections are given too quickly or at too high a concentration

Uncommon risks include:

  • Necrosis of the skin (death of the skin tissue) if the sclerosant gets outside the veins (It's important to know that the choice of sclerosant chemical can lower this risk. Polidocanol, which has been used in the United States since 2010, has fewer reported side effects than other sclerosants. In particular, it has a dramatically lower risk of skin necrosis, because it's actually an anesthetic rather than an irritant.)
  • Deep vein thrombosis
  • Accidental injection into an artery

Surface laser therapy for varicose veins

Your doctor can treat small-to-medium varicose veins with a laser through the skin, much like with spider veins. Different kinds of lasers can penetrate the skin and reach the veins. Although the skin is cooled to avoid burning, patients still report that surface laser treatment tends to be more painful than sclerotherapy.

Endovenous laser therapy

Endovenous laser therapy (or EVLT, sometimes called endovenous laser treatment) is an effective treatment for larger varicose veins in which a laser probe is inserted directly into the vein through a catheter while the doctor observes through ultrasound imaging. As the laser probe is withdrawn, the intense heat from the laser cauterizes the vein from the inside, causing it to collapse. A single EVLT procedure is more effective than sclerotherapy, which requires multiple sessions.

EVLT is an alternative to foam sclerotherapy in some cases, as well as to other types of heat-based cauterization (ablation), such as using radio waves, and to surgical procedures requiring general anesthesia, such as removing (or "stripping") the vein or tying it off (ligation).

Both radiofrequency ablation and EVLT have been shown effective and with rates of complication that are lower than the surgical approaches.

In one study conducted at a hospital that used EVLT as its primary method of treating varicose veins, out of 319 patients studied, 96 percent achieved a satisfactory result (the vein closed up as expected). There were no burns and no cases of deep vein thrombosis (DVT), a potentially life-threatening condition that stems from a blood clot. Side effects in general were described as being "minimal."

Updated October 13, 2014


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