by Jennifer Heller, MD and Lowell Kabnick, MD
Long established as effective modalities, injection sclerotherapy, and to a lesser extent laser and IPL, have dominated the market for patients who desire resolution of unsightly spider veins. Although these treatment options are reliable and provide reasonably good results with more pronounced C1 disease, such as the dark blue reticular veins and the thick red spider veins, limitations do exist for eradication of very fine spider veins. Additionally, patients must be compliant with use of compression stockings and avoid sun exposure for several weeks post-treatment in order to optimize results and minimize complications such as hyper/hypopigmentation and pain - side effects which have been documented particularly with IPL and laser treatment.
In an effort to improve upon these limitations, a group of European phlebologists, spearheaded by Dr. Brian Newman, joined together to create a new technique for spider vein treatment. Their development was created in the form of a radiofrequency device called Veinwave™. In July 2001, Veinwave™ was introduced in Great Britain as well as to the International Phlebology Community. In June 2009, the FDA provided Veinwave™ clearance to market in the United States.
Veinwave™ is a radiofrequency-desktop-device, which uses a pen-like needle holder into which an ultra-fine insulated needle is inserted. Utilizing the principle of thermocoagulation, this needle emits safe energy (regulated by a foot-pedal) via a uni-polar current at the needle-tip. The Veinwave™ system enables the practitioner to specifically target each individual vein for treatment. The technique involves a sub-epidermal insertion of the needle-tip along the length of the vein, but without penetration of the target (vessel). A unique micro sheath surrounding the needle protects the epidermis from any trauma.
The patient can appreciate the remarkable, practically instantaneous change in the appearance of these fine veins. In contradistinction to other spider vein treatment, patients who undergo Veinwave™ therapy may resume normal activity immediately following their appointment. Abstaining from sun exposure is only recommended for a couple of days instead of weeks. Some patients leave the treatment without significantly visible skin signs, while others with more sensitive skin, may have minor erythema, which should disappear within a four to twenty-four hours. The sensation experienced during treatment is similar to that of a warm pin prick or a minor sting. Any discomfort is said to be less painful than most laser or IPL treatments.
Our present but limited experience (confirmed by Dr. Newman) reveals a 60% area reduction of leg telangiectasias less than 0.3 mm and greater than 90% of facial veins (see figure 1 and 2). This appears to be similar to cutaneous laser without the concern of Fitzpatrick skin types, sun exposure, and hyper/hypopigmentation.
Veinwave™ will not likely replace other techniques for treatment; rather, it will enhance our ability to treat all forms of spider veins and allow phlebologists to treat the very fine spider veins in concert with the larger telangiectasias, thereby increasing patient and phlebologist satisfaction alike. Early reports are extremely optimistic, and undoubtedly, Veinwave™ will occupy a bright light in the armamentarium for spider vein treatment.
Lowell Kabnick, MD, FACS, FACPh, RPhS is the Director of the New York University Vein Center and an Associate Professor at New York University Langone Medical Center, Division of Vascular Surgery.Jennifer A. Heller, M.D., FACS, is Assistant Professor of Vascular Surgery at The Johns Hopkins University School of Medicine, and Medical Director and Chief of The Johns Hopkins Vein Center.