How are varicose veins and spider veins (telangiectasia) treated?

Updated: Sep 25, 2020
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Superficial varicosities are the result of high-pressure flow into a normally low-pressure system. Varicosities carrying retrograde flow are hemodynamically harmful because they cause recirculation of oxygen-poor, lactate-laden venous blood back into an already congested extremity. The primary goal of treatment is the ablation of these reflux pathways with resulting improvement of venous circulation.

In the rare setting of deep system obstruction, varicosities are hemodynamically helpful because they provide a bypass pathway for venous return. Hemodynamically helpful varices must not be removed or sclerosed. This condition is encountered rarely, but when it is, ablation of these varicosities causes rapid onset of pain and swelling of the extremity, eventually followed by the development of new varicose bypass pathways.

Sclerotherapy, laser and intense-pulsed-light therapy, radiofrequency (RF) or laser ablation, [7] and ambulatory phlebectomy are the modern techniques used to ablate varicosities. Numerous reports describe success rates of greater than 90% for less invasive techniques, which are associated with fewer complications, with comparable efficacy. [8, 9]

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