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How do you choose whether to use injection or lasers for varicose veins?

This question was asked in Irvine, California and has 8 answer(s) as of 01/16/2013.
How do you choose whether to use injection or lasers for varicose veins?


Doctors Answers (8)

You can't choose between injections or laser; you can only choose the right doctor. If you chose a physician that is well trained and experienced in the diagnosis and treatment of venous disease, that doctor will be able to tell you which treatment is most appropriate for you. The only choice you need to make is the right doctor.

Injection works well for veins that are not straight - the vein is destroyed from the inside by the liquid or foam sclerosant medication, which can fill even the most complex network of veins. However, if the diseased vein is reasonably straight, either laser or radiofrequency ablation is more likely to produce a successful result.

The decision on how to treat spider veins and varicose veins depends on the size (diameter) of the vein, as well as the personal preference, skill set, and office equipment of the treating physician. For the treatment of spider veins, I prefer to use injections with the FDA approved medicine called polidocanol. This process is called sclerotherapy. In most cases, it is less painful than laser treatment, more time efficient, and a wide range of vein diameters can be treated. I use surface laser therapy for small spider veins (less than .5 mm in diameter), for veins on the face, for patients that are allergic to sclerotherapy medicine, or veins that are resistant to sclerotherapy. I believe a narrow beam, hemoglobin absorbing laser is best, such as the 940 nm wavelength laser. By definition, varicose veins are abnormal, bulging veins greater than 3 mm in diameter. Varicose veins are usually associated with venous insufficiency of deeper, feeder veins. It is important to treat the underlying venous insufficiency with endovenous laser ablation or radiofrequency closure before treating the varicose veins. Then the varicose veins can be treated with ambulatory micro-phlebectomy or sclerotherapy.

Varicose veins are treated with an endovenous laser (meaning laser placed inside the main vein) Injections are a complementary or adjunctive method used after the laser is done to clear any residual veins.

This decision is mostly based on which vein is damaged and its' size. Smaller superficial varicose veins that are less than 1cm are very effectively treated with sclerotherapy. Larger vessels that feed these varicose veins such as the Greater Saphenous Vein (the large vein that runs from the ankle to the groin) and Small Saphenous Vein (the large vein that runs from the back of the ankle up the calf) are best treated with endovenous laser. During this process a 1/2mm laser fiber is inserted into the damaged vessel and used to close it. Only an ultrasound can determine if the larger vessels are damaged so it should be included in any good vein evaluation.

Expert use of *endovenous* thermal energy (laser or radiofrequency used * inside* the deeper, larger saphenous veins) provide the most durable result often combined with sclerotherapy to the surface varicosities with a 95% success rate. Injections used alone can also work well but at a 75-80% success rate. While both methods have minimal risks, thermal ablation costs about 40-50% more than injections.

How do you choose whether to use injection or lasers for varicose veins? injection therapy also know as sclerotherapy is very versatile treatment and it can be used very effectively on veins of most sizes, from the tiny spider veins to the large ropey varicose veins. on the largest superficial vein called the saphenous vein a endovenous laser is the most effective. on the very smallest spider veins that a fine red threads the laser is also effective. so in summary a laser is used on the biggest veins and the tiniest veins, and sclerotherapy is used on the veins middle sizes.

Ultimately it is a choose that you would have to make. We prefer injection therapy as opposed to laser treatment. We have found that we get much better results, less pain involved, and much less costly.

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