Varicose veins develop gradually and progressively. They are unsightly and are often a source of considerable discomfort. Symptoms often become worse during the menstrual cycle and pregnancy. The symptoms can include:

  • Aching, tenderness
  • Heaviness, fatigue
  • General restlessness in the legs
  • Burning pain
  • Throbbing pain
  • Itching
  • Leg cramps, particularly at night
  • Ankle swelling
  • Skin discoloration at the ankle
  • Skin ulcers above the ankle

Varicose veins are not preventable; however, there are some things you can do to ease mild symptoms:

  • Exercising to strengthen leg muscles to help push the blood back to the heart (walking, bicycling, and swimming are recommended).
  • Maintaining ideal body weight
  • Wearing graduated elastic support hose that are properly fitted to your size and with the compression level recommended by your physician
  • Elevating the legs eases discomfort

Varicose and spider veins will not disappear by themselves. The effects of faulty valves and the pressure of gravity continue to work on the veins, causing them to stretch further and to become more extensive.

The changes in the size and number of varicose and spider veins are difficult to predict. They vary greatly from patient to patient. Some varicose veins do not change but recent studies indicate that 20% of untreated varicose veins worsen and become leg ulcers, which are painful and difficult to heal.

Therefore, it is important to pay attention to symptoms and to have a thorough clinical evaluation.

A specially trained physician performs this procedure using a very fine needle to inject a safe, effective sclerosing agent directly into the blood vessel. The effectiveness of the procedure comes as a direct result of the training, experience, and judgment of the physician to make sure that the sclerosant’s volume, concentration, and exposure time are exactly right.

The solution displaces the blood in the vein, causing it to immediately appear lighter in color and sometimes vanish. Further, the solution irritates the vein lining, causing it to collapse and blocking it from getting more blood. Within a few weeks the unused vein is absorbed by the body and disappears. The number of injections done in one session and the number of treatments required varies according to the size and location of the veins and the patient’s overall medical condition. The Sclerotherapy procedure for large veins takes about 30 to 45 minutes. Typically, several visits, usually fifteen to thirty minutes long, are scheduled a few weeks apart for spider vein treatment. The first treatment for large veins is followed up three to weeks later and veins that were not treated are injected. There is another follow-up at three months and then again at a year. A laser may be used in later treatments to obliterate the smallest remaining veins and discoloration.

It is important to complete the series of recommended treatments to make sure that all of the veins have been removed. Many patients quit treatment once their legs look good enough. This is a mistake because venous disease is progressive and the remnants of the veins left in the legs can quickly grow into more veins.

Your legs will look worse before they look better; however, spider veins generally respond to treatment in three to six weeks while larger veins respond in three to four months. Symptomatic relief is almost immediate because eliminating varicosities actually improves the body’s ability to carry blood by redirecting it to the healthy veins. Scelerotherapy has a success rate of 80-90% when done by an expert.

For spider veins, most people require two to five treatment sessions. Some people do not see visible results until after the second session. Spider veins develop over a period of years and do not go away by one treatment session although some patients report that symptoms resolve as early as after the first injection session.

Effectively treated varicose veins do not grow back. New veins may appear over time because if you have weak valves in other veins as well. Over time, multiple factors cause the weak valves to give, eventually forming what appears to be new varicose veins. Think of sclerotherapy as maintenance for the looks and life of your legs.

No. On the contrary, removal of diseased vessels improves circulation because varicose veins are a burden on your circulation. In treating varicose veins, we eliminate only the bad veins, leaving the healthy veins, which the  body naturally uses to return blood from the heart.

There is minimal pain in sclerotherapy but individual injections can cause a slight burning sensation, similar to an insect bite, for a few seconds. We use a sclerosant that was developed as a local anesthetic so it does not sting or burn like some other sclerosants. No pain medication is required to have sclerotherapy.

La Jolla Vein Care is now offering Pain Free Cryo Sclerotherapy!

What is Cryo-Sclerotherapy?
Cryo-Sclerotherapy is sclerotherapy in combination with a Cryo device. What this does is cool the surface of the skin before, during, and after injections. It is intended to minimize pain during injections by providing temporary anesthetic relief. This does not interfere with the results of treatment.
Call La Jolla Vein Care now to upgrade any Sclerotherapy appointment to Cryo-Sclerotherapy for an additional $100.

You should wait three months after major surgery or pregnancy. People with clotting disorders, suppressed immune systems, those with deep vein thrombosis or incompetence, and patients who cannot walk for other reasons are not good candidates for vein treatment.

No medical therapy has a 100% cure rate or is performed with 0% risk; however, complications are uncommon and relatively minor. Possible side effects include redness and swelling on the injection site, but these typically go away in a day. Brown lines or spots sometimes appear on the site where larger veins were treated. These generally disappear within a year. There can be temporary bruising or a mild allergic reaction to the sclerosant but this is quite rare. Lumps can appear in injected vessels. This coagulated blood and not dangerous.

Prominent hand veins can be treated with sclerotherapy. Enlarged hand veins are normal and do not cause pain. They appear more prominent as one ages as a result of decreased collagen in the skin. As the skin becomes thinner, the hand veins appear larger. Treatment is purely cosmetic. Dr. Bunke developed the ScleroFill(TM) hand rejuvenation procedure which combines sclerotherapy of hand veins with the injection of a collagen filler to enhance the youthful appearance of the hands.

Compression following sclerotherapy is an adjunct to the treatment. Our experience and current medical literature supports the use of compression to insure the best possible cosmetic result. Your legs will feel better if you wear compression hose at least during the day for several weeks after treatment. If your occupation involves standing or heavy work or if you have chronic venous disease, it is recommended that your wear compression hose on the job and also when engaging in any sort of vigorous activity during the day.

Physiologically, compression therapy increases venous blood flow back to the heart, reduces reflux in diseased veins, increases venous blood flow, reduces elevated water content of the tissue, reduces inflammation, and sustains reparative processes. In short, compression therapy not only improves results after treatment, but it also improves blood flow and reduces leg swelling and symptoms.

No. Over-the-counter products or TED hose do not provide sufficient compression. There is a medical science to the concept of graduated compression therapy. The concept of compression therapy lies on a simple and efficient mechanical principle: it consists of applying an elastic garment around the leg that exerts a controlled pressure on the limb. By compressing the limb with graduated compression, which is strong at the ankle and decreasing going up the leg, the compression stocking helps the venous return, decreases venous pressure, prevents venous stasis and impairs of venous walls, and efficiently relieves aching and heavy legs. This level of compression can only be achieved by medical grade, prescription only stockings. Depending on the pathology, medical compression therapy can be applied in different forms: socks, stockings, pantyhose, or bandages.

It is estimated that 70% to 80% of pregnant women develop varicose veins during the first trimester. Pregnancy causes an increase in blood volume, but it is hormonal changes that cause the veins to enlarge. Elevated levels of progesterone, which the body produces to stabilize the uterus, allow veins to dilate. Later, the uterus enlarges and causes increased pressure on the veins in the pelvic area. 60% to 80% of varicose veins that develop during pregnancy disappear a few months after delivery, but it must be remembered that damaged venous valves do not repair themselves.

If after three months following a delivery the varicose veins are still present, they are not likely going to regress. We suggest waiting 12 weeks postpartum.


Most insurance types cover the treatment of varicose veins, if it is a medical necessity. This means that the varicose veins must cause considerable pain and symptoms or have ruptured or cause leg ulcerations. Most insurance types also require a trial period of wearing compression stockings.

Insurance does not cover cosmetic services. As a result, they do not cover spider vein treatment or treatment of varicose veins when performed for cosmetic reasons (e.g., if varicose veins are not painful or do not cause symptoms they could be considered a cosmetic treatment by insurance).

We receive and treat patients from around the world. Our offices are conveniently located 20 minutes from the San Diego International Airport, 90 minutes from LAX, and 45 minutes from TIJ. We can arrange to have you met at the airport and brought to and from our office until your treatment needs are met. A wide variety of local hotel accommodations, from affordable to ultra luxurious, are available in the area. Please contact us today at 858-550-0330 and we’ll be happy to assist you in these arrangements.

Varicose veins and spider veins develop gradually and progressively. They are unsightly and are often a source of considerable discomfort. Both varicose veins and spider veins can cause symptoms. Symptoms often become worse during the menstrual cycle and pregnancy for women. The symptoms can include:

  • Aching, tenderness
  • Heaviness, fatigue
  • General restlessness in the legs
  • Burning pain
  • Throbbing pain
  • Itching
  • Leg cramps, particularly at night
  • Ankle swelling
  • Skin discoloration at the ankle
  • Skin ulcers above the ankle

Yes, restless legs symptoms is a common symptom of varicose veins. We have published our own studies showing this correlation and that symptoms of restless legs can resolve or decrease after vein treatment.

Yes, varicose veins are a common cause for night cramps, that can wake you from sleep at night.

The great saphenous vein (GSV), previously referred to as the long saphenous vein, is a superficial leg vein that runs from the top of the thigh near the groin, down the inner thigh all the way to the inner ankle. The top blue arrow in this diagram points to the location of the great saphenous vein.

The Great Saphenous vein is responsible for varicose veins about 80% of the time. When varicose veins appear in the inner thigh or calf areas, the GSV is often the culprit (see picture). The other superficial vein largely responsible for varicose veins in the small saphenous vein. The small saphenous vein (SSV) runs along the back of the calf. The SSV was previously referred to as the short saphenous vein. Varicose veins on the backside of the leg are often caused by leaky valves.

See our blog posts for more information

A diseased, dilated, stretched out saphenous vein would not be used for bypass surgery. There are other veins in the body that can be used. For that reason, treatment of a diseased saphenous vein will not prevent a person from having heart bypass surgery in the future if needed.

The goals of treatment are to relieve symptoms, prevent complications and for some to improve appearance.  Lifestyle changes can ease the symptoms but do not cause the veins to vanish.  These include:

  • Avoid standing or sitting for long periods of time:  To keep blood moving when you have to sit or stand for long periods, try these tips: at work, take walking breaks and try walking during your lunch hour. While sitting, try flexing your feet up and down 10 times an hour. When standing, raise yourself up and down on your toes or rock back and forth on your heels.
  • Exercise: Exercising is good for your veins because it improves blood flow. Walking, cycling, or swimming are great exercises for vein health. But be sure to check with your doctor before starting any exercise program.
  • Weight loss or maintaining a healthy weight: Being overweight puts extra pressure on your veins.
  • Leg elevation: Use leg elevation three or four times a day for about 15 minutes at a time. Even elevating your legs on a step stool or ottoman is beneficial. If you need to sit or stand for a long period of time, flexing (bending) your legs occasionally can help keep blood circulating. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms.
  • Compression stockings: These elastic stockings squeeze or compress the veins and prevent blood from flowing backward. Compression stockings must be graduated, medical grade compression to be beneficial. Over the counter support hose or TED hose are not adequate to reduce symptoms in venous disease for active patients.
  • Supplements such as horse chestnut and grape seed extract can help reduce symptoms of venous disease
  • Anti-inflammatory medications such as ibuprofen
  • ice packs can be applied to veins that are tender to reduce inflammation

Varicose veins are not associated with heart disease and do not indicate a problem with the heart.  With varicose veins and venous insufficiency, the vein valves are weak and leaky. But, only the valves in the leg veins are affected. These valves are different than heart valves.  Additionally, heart disease

healthy_and_diseased_valvesoften refers to problems with the arteries of the heart or the heart muscle itself, not veins. In sum, if you have varicose veins, it does not mean that you are more likely to have problems with the heart.

Over time, complications can develop from untreated veins. These include:

  • Superficial phlebitisstp
  • Skin discoloration and eczema around the ankle
  • Skin sores or ulcers usually near the ankle
  • Burst or hemorrhaged vein

The cost of cosmetic spider vein sclerotherapy depends on how extensive the treatment session. You only pay for what you need; the cost is $100 per vial of sclerosant.  Most patients need 1-3 vials per leg. Therefore, costs commonly range from $100 to $300 per leg.  For extensive spider veins, there is a 5 vial maximum (up to a maximum of $500 per leg). For minor vein conditions, both legs may be treated at the same time. For more extensive spider veins, the provider may recommend to do one leg at a time for the safest and most effective treatment.

Most patients will need 2-5 treatment sessions of sclerotherapy per leg spread out over a few months for optimal results. There is fading with each treatment session.

Since everyone’s needs are different, a consultation and ultrasound examination is required to make a definitive treatment plan. Based on the patients specific treatment plan, an accurate cost estimate can be given.

Many insurance plans will cover the cost of varicose vein treatment if medically necessary. If not, a cash option can be given.

A thrombophlebitis is swelling and inflammation of a vein caused by a blood clot. There are two main types of thrombophlebitits: deep venous thrombosis (affects deeper, larger veins) and superficial thrombophlebitis (affects veins near the skin surface).  This is often referred to as an STP.

The following symptoms are often associated with thrombophlebitis:

  • Inflammation (swelling) in the part of the body affected
  • Pain in the part of the body affected
  • skin redness (not always present)
  • Warmth and tenderness over the vein

The following increase your chances for thrombophlebitis:

  • Being hospitalized for a major surgery or with a major illness
  • Disorders that make you more likely to develop blood clots
  • Sitting for a long period of time (such as on a long airplane trip)
  • Varicose veins

An STP is common complication of varicose veins. But, it can also indicate an underlying problem with blood clotting.  In some cases, there may also be a concurrent blood clot in other veins, such as the deep veins (DVT) which can be serious. For this reason, a duplex ultrasound examination is used to look at the deep veins and other veins not visible to the naked eye for the presence of blood clots.

If it is localized to a small surface vein, it can usually be treated with  aspirin or other anti-inflammatory medication to reduce pain and inflammation, compression stockings, and cold/warm packs to also reduce inflammation and discomfort. The discomfort is usually improved within 6 weeks but it can take a few months to resolve.

If the superficial thrombophlebitis is extensive or if it appears to be ‘migrating’ up the leg, a blood thinner may be necessary.  You should see your doctor if you develop an STP.


A sclerosis agent is a medication that is used to treat spider and varicose veins. There are different sclerosing agents that can be used, but we prefer to use polidocanol. The brand name for polidocanol is Asclera. Polidocanol is the most commonly used sclerosant world-wide because it is safe, and yields great results with few side effects. Please read Dr. Bunke’s book for a more in depth understanding of these medications.

Below, is a description of Asclera from the manufacturer’s website.

What Is Asclera®sup> (pronounced a skler ah)?

Asclera® (polidocanol) Injection is a prescription medicine that is used in a procedure called sclerotherapy and is administered by a healthcare provider to treat two types of veins:

    • Uncomplicated spider veins (very small varicose veins ≤ 1 mm in diameter)
    • Uncomplicated small varicose veins (1 to 3 mm in diameter) known as reticular veins

How Does Asclera® Work?

Asclera® is a sclerosing agent that is injected into the vein. It works by damaging the endothelium, the cells lining the inside of blood vessels. This causes blood platelets and cellular debris to attach to the lining of the vessels; eventually, cellular debris and platelets cause the blood vessel to clot. Over time, the clotted vein will be replaced with tissue.

Cryo-Sclerotherapy is sclerotherapy in combination with a Cryo device. What this does is cool the surface of the skin before, during, and after injections. It is intended to minimize pain during injections by providing temporary anesthetic relief. This does not interfere with the results of treatment.
Call La Jolla Vein Care now to upgrade any Sclerotherapy appointment to Cryo-Sclerotherapy for an additional $100.

Find your answer? If not, call our staff at 858-550-0330 and they can happily answer any question.

If you have a question you would like to be answered here or on the blog, email Dr. Bunke at