Sclerotherapy vs Laser Vein Therapy - Which is Best?
- Asked 4 years ago
there are a both spider veins and varicose veins showing on my thighs and lower legs. would doctors recommend laser therapy for treating both of these problems? or would i get a combination of laser therapy & sclerotherpay?
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VAricose vein treatment
Vnus or evlt ( radiofrequency ablation or laser) work best on varicose vein tributaries including the greater saphenous and lesser saphenous veins. if these dont completely shut down the varicosities then sclero therapy using a 1 to 3 % strength sotradecol foam therapy vis ultrasound guidance or microphlebectomy.
There is optimal treatment technology for each vein treatment
Most patients have a combination of spider veins, reticular veins, and varicose veins. The reason that patients develop these types of "extra" veins is that there is likely venous reflux of some sort.
What is venous reflux? It means that the veins that usually let blood flow in one direction (back to the heart), are malfunctioning because the valves that allow blood to flow toward the heart, are actually allowing the blood to flow back down to the feet. This causes blood to pool in the veins under pressure and create "varicose veins" and "spider veins."
Therefore, the optimal treatment for the different types of veins that form on your legs depends on the diagnosis or evaluation of the deeper veins (with a duplex ultrasound), to evaluate the health of the deeper veins which give rise to the smaller veins (varicose and spider veins). If this is not done, and the root cause of your veins are not treated appropriately, you are destined to have failure of therapy.
Far too often, I have seen patients have multiple treatments of sclero or laser, etc. If you want to avoid having the same treatment over and over, my advice is to see someone who uses all of the available technology that treat your veins appropriately and effectively.
What's better, sclerotherapy or laser therapy?
We are often asked by patients this type of question during the consultation - what is better, sclerotherapy or laser vein therapy? I turn the question around and ask my patient the following question: what is better, an SUV or a sports car?
The typical response is, "it depends" on what you want to do with it. You don't drive a Corvette when its snowing and you don't taunt a Ferrari when you're in your SUV. Each vehicle serves its purpose. So is the case with sclerotherapy and laser treatment of telangiectasias or spider veins. No matter what technique is used, it is important for the physician to treat underlying varicose and reticular veins before sclerotherapy or laser therapy is attempted in order to reduce the likelihood of recurrence.
Beyond this important fact, after treating venous reflux or perforator venous reflux contributing to the formation of these spider veins, the practitioner that has a wide clinical experience can choose whichever treatment is best - in my case selctively choosing sclerotherapy or laser therapy depending on the type, size and color of the spider and reticular veins being treated.
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Sclerotherapy and laser treatment of spider and varicose veins
Treatment of spider, reticular, and varicose veins begins with a complete mapping of the vein network and evaluation of venous reflux. This should be done by a surgeon who is board certified in phlebology. I perform a combination of reticular, spider sclerotherapy and selective photothermolysis with laser.
Sclerotherapy is best but you may need laser for complete treatment
Sclerotherapy is the injection of a solution into the vein to cause it to get irritated and turn into a tiny scar that is invisible and cannot carry blood. Sclerotherapy is the best way to treat most leg veins. However, the smallest, thinnest veins may be too small to treat with sclerotherapy. The only method to treat these little veins is with laser, which doesn't work for all vessels. Blood vessels on the legs are much more resistant to laser treatment that vessels on the face or chest.
If you have bulging leg veins, or your legs tend to swell at the end of the day, you should see your doctor before having your leg veins treated with sclerotherapy. You may have leaky veins deeper in your legs that should be treated before you have sclerotherapy.
Combination but Sclerotherapy is Superior
Sclerotherapy has a lot of advantages to laser vein treatments. It is more effective and cheaper. However, it is quite technique dependent. I have attended laser "courses" which are really courses masquarading as sales sessions. When they get to the vascular part when they are touting their laser, they seem to skip the sclerotherpy. When I query the physician about sclerotherapy , they will often mutter that the patient (client sometimes) should be referred to a dermatologist if they ask for that.
Sclerotherapy, in good hands will eradicate about sixty per cent of spider veins. However, just because a vein was hit, does not mean it will go away. Also, unless one is rid of the deeper veins (NOT THE DEEP SYSTEM) they will eventually recur.
Laser with the 1064 ndYag is good for mopping up the smaller veins that sclerotherapy cannot destroy. It also helps to eradicate the small veins that occur after sclerotherapy called matting (as the small veins are destroyed, smaller vessels can form at the periphery).
If you have tiny veins to start out with then laser vein therapy would be a better route.
Sclero vs Laser for spider veins
Sclerotherapy is considered the gold standard for the treatment of telangiectasias, the small spider veins visible in patients with leg vein disease. Larger blue veins, and even varicose veins, may be amenable to treatment with sclerotherapy, but this often requires treatment with foamed solutions, and sometimes with the aide of ultrasound guidance. Rarely, the very smallest veins are unsuccessfully treated with sclerotherapy and an Nd:YAG laser may be used to treat them. Alternatively, for patients with varicose veins or significant leg vein disease, I advise evaluation by ultrasound. Depending on the findings, endovenous laser ablation of larger veins such as the great saphenous vein may be necessary.
Sclerotherapy is still the gold standard
As stated by some of my colleagues, sclerotherapy is technically much more difficult but yields better, more reliable results for leg veins. Over the years, there have been many lasers and IPL devices that have been developed to try to compete with the efficacy of sclerotherapy...but to date, none have succeeded. Lasers are great for facial telangiectases (small dilated vessels) but due to several different reasons, they are not as effective for leg vessels.
I hope you find this helpful.
Laser plus sclerotherapy plus surgery may ALL be required for optimal management of varicose veins
Often times this is not an either/or decision. These two modalities can be complementary. Furthermore, the use of surgery is still occasionally required. In any event, maintenance therapy will be required and it is important to understand and be prepared for this.
Usually, sclerotherapy is best
In an very independent study performed by one of this country's leading laser surgeons, Dr Tina Alster, she found in most patients that sclerotherapy was more efficient and less expensive than laser. Of course, very tiny matted vessels that are too small for the needle may respond just fine to certain long pulsed vascular lasers such as the NdYag. It is important to get global treeatment of any feeder vessels and not just spider veins. Some patients with severe disease may need ambulatory phlebectomy or intra-vessel laser closure to large varicosities. Good luck!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.