It may be necessary
Without seeing your leg and ultrasound it is tough to say. However, it is often necessary to treat the larger refluxing veins before doing sclerotherapy. Otherwise, its like painting over a crack in the wall. It may look better temporarily but the crack is still there and will likely return.
EVLT and spider veins
EVLT is performed for the treatment of large vein reflux. This type of reflux can lead to multiple spider veins in the affected leg. It is important to have a proper evaluation prior to getting sclerotherapy of smaller spider or thread veins. Small vein treatment without treating the larger vein first can lead to a worse cosmetic appearance over a short time.
Spiders with EVLT
It is important to treat the source or cause of the problem. Often people see small spider veins or discolorations in their ankles which is really caused by insufficiency in larger veins further up the leg. It is important to treat the source of the problem with get rid of the veins correctly. That being said I would not do EVLT unless you have symptoms of leg pain, swelling or other complaints and would discuss with your physician the best treatment options and plan
I know it's not 100% but does EVLT really work for spider veins?
Treating the underlying vein problem is important before treating the superficial spider or thread veins. Thread veins can be treated with laser or microsclerotherapy
EVLT and Spider Veins
If all the diseased veins of the superficial venous system are treated (saphenous veins, accessory veins, tributaries, perforator veins, etc), then your venous insufficiency should be taken care of. This will help reduce the number of current and future spider veins (and varicose veins, of course) as abnormal pressures and circulation will be eliminated. I always tell this to my vein patients. I also tell them that I can not promise to get rid of all future spider veins completely and semi-regular maintenance sclerotherapy may be needed. But all my treated patients note a significant difference in their spider veins and how their legs feel.
Hope this helps and take care,
EVLT treats venous insufficiency, not necessarily spider veins or varicose veins - Buffalo NY
EVLT is done for venous insufficiency at the saphenofemoral junction, saphenopoliteal junction, for segmental venous insufficiency below the knees and also venous insufficiency for perforator veins in the thighs, upper and lower legs. EVLT is FDA approved to treat venous insufficiency and by reducing venous reflux or pooling of blood in the lower extremities, it lowers venous hypertension, and therefore reduced the driving force for the development of varicose veins, reticular veins and spider veins. You should have SYMPTOMS in order to be treated for venous insufficiency - aching, pain, heaviness, tiredness and fatigue of the legs, itching, burning, cramping and throbbing of the legs, and ankle or leg swelling. Read the ebooks about the EVLT procedure provided on the link below:
EVLT does not treat spider veins and you will need sclerotherapy and/or topical laser treatments for spider veins..
Some spider veins will always recur.
EVLT is used to close the malfunctioning (refluxing) valves in usually the saphenous system of veins. The reason to do this is because, if the blood is backing up through the valves, then the pressure will increase in the side branches leading to both spider and varicose veins. Think of your veins like a tree with the saphenous system being the trunk and the spider and varicose veins being the branches. Assume the branches have a problem (spider and varicose veins). Pruning the branches will not help if the problem is in the trunk. So, if the valves in the trunk don't work, the branches will not get better until the trunk is fixed. With significant reflux, the recurrence rate of spider and varicose veins is high. If you have minimum reflux then you may be able to just treat the spiders. This will buy you time but, most likely, the spiders will recur over time.