Spider Veins

What are spider veins?

Spider veins are the fine, thread-like reddish veins at the surface of the skin. Spider veins are not healthy. Spider veins are are often considered a cosmetic issue, but they can be associated with underlying feeder veins, not visible to the naked eye. Feeder veins are the ‘blue veins’ also known as ‘reticular veins,’ that give rise to spider veins. Spider veins may also be a sign of underlying venous insufficiency. For example, spider veins located in the inner ankles and inner thighs can indicate an underlying problem with the saphenous vein. As a result, an ultrasound examination may be recommended to identify and effectively treat the underlying source of the spider veins.

What are the symptoms of spider veins?

Vein conditions affect people differently. For some, spider veins can be a painless cosmetic concern, and for others they may cause symptoms. The most common symptoms of spider veins are burning, throbbing, and localized pain. They can also feel hot and itchy and bleed.

What causes spider veins?

Spider veins in the legs are caused by the same condition that causes varicose veins. Leaky vein valves allow blood to pool within the veins causing them to stretch and become enlarged. Spider veins on other areas of the body, such as the face, and chest can be caused by sun damage, hormone changes or liver disease. Hormones, such as with pregnancy, birth control or hormone replacement therapy can weaken the vein wall.

HOW ARE THEY TREATED?

Spider veins on the legs are most commonly treated with sclerotherapy. Sclerotherapy involves injecting a liquid sclerosant medication, that causes the veins to seal shut, scar and gradually disappear. More than one treatment is typically recommended. Lasers can be used to treat fine spider veins, but sclerotherapy is considered the ‘gold standard’ for spider vein treatment.

Spider veins and reticular veins of the legs are most commonly treated with sclerotherapy. Sclerotherapy involves an injection of a medication into the vein. This will cause the vein to collapse and gradually fade away. Sclerotherapy has been used to treat spider veins for decades, but newer solutions such as AscleraTM allow for spider veins to be treated with minimal discomfort and immediate return to activities. Vein specialists rarely use saline solutions these days, because alternatives solutions are less painful and better tolerated. Sclerotherapy is preferred by most vein specialists over laser because spider veins often have underlying ‘feeder veins’ that can easily be treated with sclerotherapy, but are not addressed by laser. Many people will require more than one treatment session for optimal results. The national average is 2 to 5 treatment sessions. Treatment sessions are often spaced a month apart, but your health care provider will help determine your customized care plan. Wearing compression stockings after treatment will improve results.

For larger veins, the medication may be turned into a foam, this is referred to as foam sclerotherapy. Foam sclerotherapy is similar to sclerotherapy of spider veins but instead of a liquid solution, a foamed-solution is injected directly into the vein via a small needle. The solution can be seen on ultrasound monitoring which allows it to be directed into nearby varicose veins painlessly. The veins will seal shut, and gradually be broken down by the body.

Sclerotheraphy injection into leg to remove spider vein

What should I expect on my treatment days?

You will sign your consent form then change into shorts provided by the office. We will clean your skin with alcohol. The sclerosant medication will then be injected into your veins with a fine needle. After your treatment, we will help you into your compression stockings, then you will walk for 30 minutes prior to getting in your car. It is normal for your legs to be achy and tender to the touch after treatment

Varicose Veins

What are varicose veins?

Varicose veins are the twisted, bulging veins just beneath the surface of the skin. Varicose veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are a common condition.

What are the symptoms of varicose veins and venous reflux disease?

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

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

Superficial phlebitis (painful inflammation of the vein)
Superficial thrombophlebitis (blood clots within the varicose veins)
Spontaneous vein hemorrhage (the vein can rupture spontaneously)
Skin discoloration and eczema around the ankle (venous eczema)
Skin sores or ulcers usually near the ankle

What causes varicose veins?

Varicose veins are caused by leaky vein valves, which allow blood to pool within the veins causing them to stretch and become enlarged. Varicose veins can be an isolated finding, but the majority of the time, they are caused by underlying venous reflux disease. Venous reflux disease is also known as venous stasis, venous insufficiency or venous incompetence. Reflux may occur in the deep and/or superficial leg veins.

HOW ARE THEY TREATED?

Conservative Management & Lifestyle Modifications

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 treatments 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 ten times an hour.

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. Check with your doctor before starting supplements.

Anti-inflammatory medications such as ibuprofen.

Anti-inflammatory topical agents such as OTC Arnica, or prescription voltaren gel may be helpful for painful phlebitis.

Ice packs can be applied to veins that are tender to reduce inflammation

Procedures for Treating Varicose Veins

Step 1: The Underlying Problem

The first step is to treat the underlying problem, the venous reflux. The specific pattern of venous reflux was detected by ultrasound. Venous reflux usually starts in the saphenous veins. The saphenous veins are most effectively treated with vein ablation procedures. This involves placing a small catheter within the vein and using heat or a solution to produce injury and eventual closure of the vein.
The treatment recommendation is customized, based on where reflux is present and other factors that need to be considered when making this decision.

The most commonly used treatments for the saphenous veins are:

radiofrequency ablation (RFA) laser ablation mechanico-chemical ablation (MOCA or Clarivein)

and in some cases ,

Varithena Foam Venaseal

These will involve the following:

Your age, overall health, and medical condition.

Extent of the condition.

The findings of your venous ultrasound.

Your signs and symptoms.

Your tolerance of specific medicines, procedures, or therapies.

Expectations for the course of the condition.

Your opinion or preference.

Step 2: Varicose Vein Treatment

After the underlying saphenous vein reflux is corrected, the bulging veins (varicose veins) can be treated by injecting a foamed medication that will cause them to scar and eventually dissolve (foam sclerotherapy), or to remove them using tiny incisions. The most common method is foam sclerotherapy. This is also known as ultrasound-guided foam sclerotherapy (UGFS). Phlebectomy is another option which includes making small incisions to remove the vein.

Ultrasound-guided foam sclerotherapy (UGFS). Phlebectomy

What patients are saying

All the staff are awesome the doctor was great and nurse practitioner the nurses they were all great I really enjoyed my visit there they made me feel very comfortable they attended and explained everything to me anything I needed or needed to be done they were there I'd recommend this place to everyone great place and the people are wonderful thank you can't wait to see you in 6 weeks.
D.R.

The entire team is professional, attentive and kind. They all make you feel as comfortable as possible when going thru an unfamiliar procedure. Their knowledge is comforting. Dr. Steinberg is outstanding! She an expert in her craft and is thorough when designing a specific plan for each patientpays close to details of a patients plan. She is detailed oriented and will make adjustments to make sure she executes the most successfull solution. I love her positivity, energy and confidence. Entire team = PRICELESS
R.M.

This place is awesome. They really go into detail with you about your problem. I have problems with the veins in my legs & they seem to really take interest in helping to find a way to sovle my problem. This is my first time here but they are very professional & really seem to care about me personally. They tend to all your needs here. Very kind people & they treat you with the utmost regard.
J.S.

What patients are saying

San Diego Vein Specialists

La Jolla

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Serving San Diego, La Jolla, Del Mar, North County and surrounding areas

ClosureFast™ an endovenous radiofrequency ablation (RFA) procedure

for the backward flow of blood (or “Venous reflux”) in your saphenous vein(s). The great saphenous veins and small saphenous veins are the two main superficial veins of the leg. They run along the inner leg and the back of the leg, respectively.

This minimally invasive procedure can be performed in the office in less than an hour and patients usually return to their usual level of activity the same day.

Video below shows the proceedure.

Read our Patient Handout

Before and After Care information

HOW DOES THE TREATMENT WORK?

The skin is numbed with lidocaine, then a tiny wire and the Closurefast® catheter are inserted into the vein. The catheter delivers radio-frequency energy to the vein wall, causing it to seal shut. The remaining healthy veins continue to bring blood back to the heart.

WHAT SHOULD I EXPECT ON THE DAY OF TREATMENT?

The skin is numbed with lidocaine, then The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. You will change into a gown and leave underwear on. Depending on the vein to be treated, you will lay on your back or on your belly. We do our best to make special accommodations (for example, if you cannot lie flat or cannot bend a knee very well) with body positioning and using pillows. We will do our best to make you comfortable. Then, we will give you the option of watching a movie or listen to music.

Once you are comfortable, you leg (s) will be prepped with cleansing solution for the sterile procedure. The doctor will perform an ultrasound to map the vein (s) to be treated. Then, a numbing agent (lidocaine) will be injected into the skin. In the numb area of the skin, a tiny puncture is made to pass the radiofrequency catheter. Your doctor will then use a needle to administer a combination of cool saline and local anesthetic around the vein either in the thigh or calf (depending on which vein is treated). This solution numbs the vein and insulates it from the surrounding tissue. After the numbing solution is applied, the vein is painlessly treated with radiofrequency energy.

Once your vein has been treated, we will clean your leg and apply a compression stocking which you will wear for 72 hours continuously. You will walk for 30 minutes prior to getting in your car.

MECHANICAL-CHEMICAL ABLATION (CLARIVEIN®)

The ClariVein® procedure

for treatment of backwards flow (or “reflux”) in your saphenous vein(s). The great and small saphenous veins are the two main superficial veins of the leg. They run along the inner leg and the back of the leg, respectively.

This minimally invasive procedure can be performed in the office in less than an hour and patients return to their usual level of activity the same day.

HOW DOES THE TREATMENT WORK?

The skin is numbed with lidocaine, then the ClariVein® catheter is placed into the unhealthy vein. The catheter closes the vein painlessly by delivering two treatments:
1. Mechanical treatment with a tiny rotating wire.
2 .Chemical treatment with polidocanol. Polidocanol is a detergent-type sclerosant medication that is commonly used in varicose vein treatment.

This technique is highly effective in closing the vein and only requires one skin puncture, similar to placing an IV.

Read our Patient Handout

Clarivein After Care Instructions

Video below shows the proceedure.

How many treatments will I need?

The number and frequency of treatments depends on a patient’s anatomy, how well the veins respond to each treatment, and the patient’s treatment goals. The national average is 2 to 5 treatment sessions to achieve 80% improvement. Some larger or resistant veins require two or more treatments to respond completely.

What should I expect on my treatment days?

The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. You will change into a gown and leave underwear on. Depending on the vein to be treated, you will lay on your back or on your belly. We do our best to make special accommodations (for example, if you cannot lie flat or cannot bend a knee very well) with body positioning and using pillows. We will do our best to make you comfortable. Then, we will give you the option of watching a movie on Netflix or listen to music. Once you are comfortable, you leg (s) will be prepped with cleansing solution for the sterile procedure.

The doctor will perform an ultrasound to map the vein (s) to be treated. Then, a numbing agent (lidocaine) will be injected into the skin. In the numb area of the skin, a tiny puncture is made to pass the Clarivein® catheter. Once the catheter and rotating wire are in place, the doctor will start the treatment. You may feel a tickling or vibrating sensation as the she treats your vein. You should have minimal to no pain during this procedure.

Once your vein has been treated, we will help you into your compression stocking, which you will wear for 72 hours continuously. You will walk for 30 minutes prior to getting in your car.

In the video below Dr. Bunke discusses the ClariVein® proceedure.

ULTRASOUND GUIDED FOAM SCLEROTHERAPY

Treats Surface Varicose Veins

Ultrasound guided foam sclerotherapy works well for treating surface varicose veins and veins that are not visible to the naked eye. The foam medication can be seen on ultrasound, which allows us to administer it precisely and direct it towards nearby varicose veins. Foam sclerotherapy can be safely used for veins that travel close to the skin or nerves. It also travels easily through veins with many twists and turns.

WHAT IS POLIDOCANOL (ASCLERA®)?

A variety of sclerosant medications can be used for veins, but we prefer polidocanol (brand name Asclera®) because it is the most comfortable for the patient and has the lowest risk of side effects. It is a detergent-type medication that injures the inner lining of the veins. This causes the vein to stop flowing, then eventually close down completely. Polidocanol has been well-studied and has been approved by the FDA since 2010 for the treatment of varicose veins and has been used in Europe for decades. Polidocanol is turned into a foam to treat larger veins. This is an off-label use of the sclerosant but very effective and well tolerated. La Jolla Vein Care providers have extensive experience with foam sclerotherapy.

Read our Patient Handout

Video below shows the proceedure.

How many treatments will I need?

What should I expect on my treatment days?

You will sign your consent form then change into shorts provided by the office. We will clean your skin with alcohol, then use ultrasound to localize the veins. The foam medication will then be injected into your veins with a fine needle. You will elevate your legs on a wedge pillow for approximately 15 minutes. After your treatment, we will help you into your compression stockings, then you will walk for 30 minutes prior to getting in your car. It is normal for your legs to be achy and tender to the touch after treatment.

PHLEBECTOMY - Surgical removal of the veins

Phlebectomy is surgical removal of bulging varicose veins though tiny skin incisions. This minimally invasive procedure is performed in the office with local anesthesia. Phlebectomy is also known as micro phlebectomy (because the incisions are tiny) or ambulatory phlebectomy.

HOW DOES THE TREATMENT WORK?

The skin is numbed with lidocaine, then a tiny puncture is made in the skin (about 1⁄2 the size of a grain of rice). We then infuse additional numbing medication around the veins. A small hook is used to bring the vein to the skin surface, then the vein is removed.

Risks of Microphlebectomy:

With any procedure, there are risks. In microphlebectomy the risks are listed below:

There is a low risk of infection at the vein removal sites, which we minimize by using sterile technique and prophylactic antibiotics. You will start the antibiotic on the morning of your procedure and continue it for 24 hours after the procedure.
As with any vein treatment, there are also very small risks of deep vein clots and nerve injury.
You will have bruising where the veins were removed, which fades over about two weeks. To reduce bruising, swelling or redness, try RECOVA cream.
A nerve injury to the skin.
Numbness or pain in the feet
Adverse reaction to sedative or anesthetic
Severe bleeding or swelling
Thrombophlebitis

What should I expect on my treatment days?

The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. We will mark your bulging veins with a marker. A small hook will be used to bring the veins to the surface. More numbing medication will be infused around the veins. You will feel pressure as the veins are removed but not pain. Usually about 10-12 veins are removed.

Once the procedure is done, we will apply skin glue to the tiny puncture sites, then sterile bandages. We will help you into your compression stocking and place an ACE wrap around the treated area. You will walk for 30 minutes prior to getting in your car. The ACE wrap can be removed that night or the next day. You will wear the compression stocking for 72 hours continuously.

Vein Conditions & Treatments

We treat, spider veins, varicose veins, chronic venous insufficiency (CVI), leg pain and fatigue, swelling and venous leg ulcers using various treatments often covered by your health insurance

Spider Veins

HOW ARE THEY TREATED?

Varicose Veins

HOW ARE THEY TREATED?

Why Patients Trust us for their Vein Care

What patients are saying

What patients are saying

San Diego Vein Specialists

La Jolla

Vista

social networks

Vein Conditions & Treatments

We treat, spider veins, varicose veins, chronic venous insufficiency (CVI), leg pain and fatigue, swelling and venous leg ulcers using various treatments often covered by your health insurance

Spider Veins

HOW ARE THEY TREATED?

Varicose Veins

HOW ARE THEY TREATED?

Why Patients Trust us for their Vein Care

What patients are saying

What patients are saying

San Diego Vein Specialists

La Jolla

Vista

social networks

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ClosureFast™ an endovenous radiofrequency ablation (RFA) procedure

MECHANICAL-CHEMICAL ABLATION (CLARIVEIN®)

VARITHENA® CHEMICAL ABLATION

VenaSeal™ closure system permanently treat varicose veins by sealing the affected superficial veins using an adhesive agent.

ULTRASOUND GUIDED FOAM SCLEROTHERAPY

PHLEBECTOMY - Surgical removal of the veins

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