Treatment of Varicose Veins
Varicose veins of the legs and superficial telangiectasias develop when faulty vein valves let blood flow backward, raising hydrostatic pressure and stretching the vein wall. Beyond the obvious cosmetic burden of bulging blue-purple veins or red, web-like networks of fine vessels, the condition causes real symptoms: aching, heavy legs, swelling, and a risk of skin damage over time.
At Haute-Derma, we take a full medical approach to leg veins: a hemodynamic assessment, Doppler ultrasound to screen for deep valve incompetence, and a combination of microsclerotherapy and long-pulse Nd:YAG vascular laser. This plan targets the diseased veins at their source, clears the fine spider veins on the surface, and keeps the risk of recurrence as low as possible.
Biological Mechanisms and Principles of Treatment
- How sclerotherapy works (chemical endovenous ablation): A sclerosing agent that injures the vein lining, such as polidocanol (POL) or sodium tetradecyl sulfate (STS), is injected into the vessel. It dehydrates and strips the endothelial cells, triggering vein spasm and a controlled, organized thrombus. Over time the vein turns into a fibrous cord with no blood flow, which the body then fully absorbs.
- How foam sclerotherapy works: The sclerosant is mixed with air or a CO2/O2 gas blend using the Tessari method (1 part solution to 4 parts gas). Foam pushes blood out of the vein and sits directly against the vessel wall without being diluted by blood, which makes it more effective in medium-sized reticular veins (1–3 mm).
- How vascular laser works (photothermal coagulation): We use a long-pulse 1064 nm Nd:YAG or a pulsed dye laser (PDL, 595 nm). The light is selectively absorbed by oxyhemoglobin and deoxyhemoglobin inside the vessel and converted to heat, which coagulates the blood, damages the vessel wall, and collapses the vein immediately.
Clinical Treatment Options for Varicose and Spider Veins
| Method / Technology | Vein Size | Advantages & Main Indications |
|---|---|---|
| Liquid microsclerotherapy (POL 0.5–1%) | < 1 mm (spider veins) | Clears small spider veins; quick, with little discomfort |
| Foam sclerotherapy (POL 1–2%) | 1–3 mm (reticular veins) | Treats reticular (feeder) veins; highly effective |
| Long-pulse 1064 nm Nd:YAG laser | 0.5–2 mm | Small leg veins; red or blue vessels on the face and legs |
| Pulsed dye laser (PDL) / IPL | < 0.5 mm | Red facial telangiectasias, cherry angiomas, port-wine stains |
| Endovenous ablation (EVLT / RFA) | > 3 mm (great/small saphenous vein) | Large, deep-system varicose veins (referred to vascular surgery) |
Our Clinical Process and Combined Protocol at Haute-Derma
- Hemodynamic Assessment and Venous Mapping: Using a vein-imaging device (VeinViewer / transillumination) together with Doppler ultrasound, the doctor pinpoints the feeder veins that drive the backward pressure. Treating these feeder veins first is the key to a lasting result.
- Layered Combination Protocol (Sandwich Technique)
- Step 1: Foam sclerotherapy of the deeper reticular veins to cut off the blood supply.
- Step 2: Long-pulse 1064 nm Nd:YAG laser to clear any remaining spider veins on the skin surface.
- Compression Therapy: Right after the procedure, every patient wears medical compression stockings (class 1 or class 2) or a compression bandage for 3–7 days. The pressure holds the vein walls together, speeds up fibrosis, and prevents blood flow from re-opening the vein (recanalization).
Managing Complications and Clinical Safety
- Post-sclerotherapy hyperpigmentation: Brown staining along the treated vein, caused by hemosiderin (iron from broken-down red blood cells) deposited in the skin. It usually fades on its own within 3–6 months. It can be helped by draining small trapped clots (microthrombectomy) at weeks 2–3, or by creams containing tranexamic acid or K-Ox.
- Skin necrosis from extravasation or intra-arterial injection: A serious complication that occurs when concentrated sclerosant leaks into the surrounding tissue or is accidentally injected into a small arteriole. Emergency management includes warm compresses, hyaluronidase injection, nitroglycerin paste, and antibiotics.
- Telangiectatic matting: A blush of very fine red vessels that appears like a pink haze around the injection site. It is usually linked to excessive injection pressure or inflammation of the vein lining. We either wait 3–6 months for it to fade on its own or treat it with long-pulse vascular laser.
- Deep vein thrombosis (DVT): Very rare. Patients are asked to walk gently for 15–20 minutes right after sclerotherapy to keep blood moving through the deep veins.
