This is a great question. The answer really depends on what type of varicose vein we are discussing. In our practice we treat small spider veins and large ropey veins in addition to veins that lie deep to the surface of the skin. Whole leg ultrasound evaluation will best analyze the venous anatomy leading to a patient’s concerns, allowing for discussion of specific treatment options and definitive surgical planning.
Recent trends have favored lesser invasive treatment modalities offering little down time, and no general anesthesia. The best treatment depends not only on the type of vein being treated, but the experience of the provider. Generally speaking, surgical stripping (removal of the great or small saphenous vein) has fallen out of favor compared to thermal ablation (heating a vein causing it to scar). Ropey veins may be treated with small incisions under local anesthesia and gently removed from the leg, or they may be injected with chemicals (sclerotherapy) causing them to shrink over time. Small veins at the surface of the skin are managed with laser/light therapies and sclerotherapy, yet sclerotherapy remains the superior option for this element of disease.
My doctor says if I have my veins treated, they will just come back. Is this true?
This is a common question, yet one that has some parallels. Do we treat diabetes or high blood pressure with one pill or one injection? Of course not! Those are chronic diseases that require monitoring over time. Varicose veins are similar in that they represent a chronic condition triggered by genetic and hormonal influences, and the effects of gravity. It is estimated that we have miles of vein network. Thus, even when the initial varicose veins are treated, others may become dilated and diseased as ongoing influences often continue to exist.
Any treatment option may fail, even in the most experienced of hands. Not all treatments are the same and there is no cookie cutter or recipe for every leg. The key to assure a durable outcome involves quality follow up including ultrasound to monitor for emergence of new disease.
