Treatment without surgery
Sclerotherapy and laser for veins
Sclerotherapy involves injecting a drug into the vein that damages its wall in a controlled way, so that it closes and the body reabsorbs it. It is a technique with decades of experience, included in the European guidelines, and useful for everything from spider veins to larger varicose veins. Transdermal laser completes the treatment of the finest veins.
Types of sclerotherapy
Liquid with micro-injectionFor spider veins and very fine veins.
MicrofoamThe drug is mixed with air to form a foam that displaces the blood and makes better contact with the vein wall. For reticular veins and small varicose veins, guided by transillumination.
Ultrasound-guided foamFor larger, branch or recurrent varicose veins, using ultrasound to check where the drug acts.
The most widely used drug is polidocanol. The 2022 European guideline recommends foam or phlebectomy for treating branch varicose veins.
What a session is like
- It takes a few minutes and requires no anaesthesia.
- There is no need to fast or take time off work: you can walk and carry on with your routine the same day.
- Several sessions, a few weeks apart, are usually needed.
- Compression may be advised for a few days after the session.
Transdermal laser
For spider veins too fine to inject, I use an Nd:YAG laser platform combined with pulsed light. The energy is selectively absorbed by the small vein, which coagulates and disappears while the surrounding skin is spared. The 2022 European guideline strengthened its recommendation of transcutaneous laser for telangiectasias. Sessions are quick and well tolerated, and the number needed depends on each case.
Side effects
According to the European sclerotherapy guidelines, the most common are mild and temporary: bruising, brown marks (hyperpigmentation) and the appearance of a fine network of vessels (matting). Rarely, foam can cause temporary visual disturbances or migraine. Serious complications, such as deep vein thrombosis, are exceptional. It is not performed during pregnancy and is considered with caution in people with previous thrombosis or thrombophilia.
Videos on this topic (in Spanish)
References
- Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29(6):338-354.
- De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184-267.
Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.
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Consultation with duplex ultrasound at Clínica Rotger, in the centre of Palma.
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