Varicose vein removal - is removing all veins near the surface the recommended procedure?

It’s important to distinguish between varicose veins and spider veins when choosing between laser therapy, sclerotherapy, and vein surgery. With two board certified vein specialists, our center uses a combination of visual examination, functional flow measurements, ultrasound, transillumination, and infrared light to map out vein networks prior to therapy. Lasers can be used to treat deep varicose vein insufficiency, vein perforators, and varicose veins. Sclerotherapy is ideal for spider veins and reticular veins. Whereas surgery is reserved for severely incompetent varicose vein segments.


Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for the question! In my practice, the removal of all veins near the surface is not a standard way to treat varicose veins. In fact, preserving healthy veins may be essential to successful treatment. I often use sclerotherapy to treat medium to large-sized veins with an injectable sclerosing solution that causes the vein to shrink.  Following the procedure, the blood is naturally rerouted to flow through healthy veins, while treated veins gradually fade and disappear from view. 
An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and obtain expert medical advice. Best of luck!

Symptomatic tributaries should be treated to promote vein health. This can be done with a combination of microphlebectomy + sclerotherapy or sclerotherapy alone.If you want a secon opinion, contact at at the link below. H Karamanoukian MD FACS RVT RPVI RPhS

A full venous reflux evaluation is recommended as an initial step before the treatment of varicose veins which regularly includes an ultrasound scan of the lower extremities to determine if venous insufficiency or reflux is present. Healthy leg veins contain valves that open and close to help the blood return back to the heart. Venous reflux disease develops when the valves that keep blood flowing out of the legs and back to the heart no longer function, causing to pool in the legs and leading to signs and symptoms such as varicose veins, leg or ankle swelling, leg heaviness and fatigue, leg pain, aching or cramping, burning or itching of the skin, restless legs, skin changes or rashes, ulcers, open wounds, or sores. Factors that contribute to the presence of venous reflux is important to mention include age, gender, family history, heave lifting, multiple pregnancies, obesity, and prolonged standing. If venous reflux test is positive and symptoms are present without any other complication, it is recommended to treat underlying venous insufficiency of the superficial system saphenous system, accessory veins, and/or tributaries veins first. For that, thermal energy treatment options as well as more innovative treatment options are available in combination with ultrasound guided sclerotherapy and/or phlebectomy if necessary. Cosmetic sclerotherapy is one option that can also take care of spider veins for cosmetic reasons. 
All the best, 

It sounds like they are suggesting to remove all the superficial veins (not deep veins) of the legs even if they are working properly. I would recommend not to do this. Varicose veins can be removed via ambulatory phlebectomy (the bulging veins). However, as Dr. Landi suggested, not all veins on the surface of the skin can be removed. Most importantly, it is not standard of care to remove all veins -- especially ones that are working properly. 

Generally, the removal  or ablation of varicose veins is recommended for painful tender veins that can cause discomfort over the course of a day. This would include that superficial saphenous veins also known as the Great Saphenous and Short Saphenous. With associated insufficiency or reflux of these veins other smaller branches can be dilated or enlarged. By treating the large Saphenous veins first significant improvement will be appreciated before any treatment is done directly to the smaller veins. A good vein specialist can get you on the right path. 

It is impossible to remove all surface veins.  In treating varicose veins, the first step is to treat the cause which is usually an underlying malfunction of the saphenous system of veins.  Once this is done then the varicose veins can be treated by sclerotherapy or removal through micro incisions.  The remaining reticular and spider veins can then be treated by sclerotherapy but there will always be remaining veins that you do not see which do not need to be treated.  Removing spiders and reticulars is a cosmetic procedure.