If you suffer from either varicose veins or spider veins, you may be wondering whether to opt for sclerotherapy or laser therapy. There are some situations in which one treatment may be better for you than the other.
Treatment of spider veins: sclerotherapy vs laser
Every patient has different needs, and you should discuss your options with your vein specialist. As a general guide:
Sclerotherapy for spider veins
Sclerotherapy is a non-surgical treatment in which your doctor injects a chemical, called a sclerosant (irritant) into a vein, causing it to collapse and dry out. It eventually gets reabsorbed by the body and disappears. Traditional sclerotherapy using a liquid sclerosant is most effective on spider veins or smaller varicose veins, especially on the hands and legs. It is sometimes used as adjunct to other vein treatments. Foam sclerotherapy can be used on larger veins.
Sclerotherapy is often the best choice for the treatment of superficial spider veins on the legs and hands because it's less expensive, faster, and more effective than laser treatment. (In one study, sclerotherapy was 50 to 70 percent effective on spider veins versus 30 to 40 percent effectiveness for laser treatment.)
It's also better for people with:
- Low pain thresholds (because sclerotherapy is generally less painful than laser therapy)
- Darker skin (because some types of lasers produces light at wavelengths that can cause discoloration in people with darker or tanned skin)
Laser and light treatments for spider veins
Laser and intense pulsed light (IPL) treatment are non-invasive, chemical-free treatments. In the hands of a skilled physician, laser or IPL treatments are considered to be the optimal way of treating spider veins on the face. Some other spider veins that are too small to be injected are also better candidates for laser treatment. Also, although laser treatment of spider veins is more expensive, possibly a bit less effective than sclerotherapy, and perceived as more painful, it's still a better choice for:
- People with a fear of needles
- People allergic to the chemical used in sclerotherapy
- Pregnant women
- Treatment of areas with patches made up of many tiny blood vessels (known as telangiectatic matting)
Laser or IPL treatments are usually performed in the doctor's office and typically take anywhere from about 10 to
You can generally return to normal activities within at most a day. The most common side effect is a temporary purple skin pigmentation that looks like bruising. And one study showed that a particular kind of laser (a potassium-titanyl phosphate, or KTP, laser) produced almost no bruising at all (just a single case out of 647), and most of the treatments were performed on the patients' face.
Treatment of varicose veins: sclerotherapy vs lasers
When deciding whether to use sclerotherapy vs laser therapy for varicose veins, here are some things to consider:
Sclerotherapy for varicose veins
Sclerotherapy, like laser or light therapy, is usually performed in the doctor's office and takes roughly the same amount of time. It involves injections, but a local anesthetic is usually given, and it's generally perceived to be less painful than laser therapy.
Smaller veins are usually injected with a liquid, while larger varicose veins are usually injected with a foam that can fill the space better and for a longer period of time. When doing foam sclerotherapy, the doctor usually guides the needle using ultrasound imaging. More than one treatment may be needed, and you will likely have to follow up by wearing compression stockings for at least several days.
Sclerotherapy side effects
The potential side effects of sclerotherapy include:
- Skin discoloration (hyperpigmentation, a darkening of the skin color) — occurs a little less than one-third of the time, and usually goes away on its own within a few months
- Itching, burning, and pain at the site (usually goes away within a few days or less)
- Bruising
- Allergic reaction to the sclerosant
- Patches made up of many tiny blood vessels (telangiectatic matting) can form if the injections are given too quickly or at too high a concentration
- Necrosis of the skin (death of the skin tissue) if the sclerosant gets outside the veins (not common)
It's important to know that the choice of sclerosant chemical can lower the risk of the side effects. Polidocanol, which has been used in the United States since 2010, has fewer reported side effects than other sclerosants. In particular, it has a dramatically lower risk of skin necrosis, because it's actually an anesthetic rather than an irritant.
Laser therapy for varicose veins
Your doctor can treat small to medium-size varicose veins with a laser through the skin, much like in laser treatment of spider veins. Different kinds of lasers can penetrate the skin and reach the veins. Although the skin is cooled to avoid burning, patients still report that it tends to be more painful than sclerotherapy.
Endovenous laser therapy (or EVLT, sometimes called endovenous laser treatment) is an effective treatment for larger varicose veins in which a laser probe is inserted directly into the vein through a catheter while the doctor observes through ultrasound imaging. As the probe is withdrawn, the intense heat from the laser cauterizes the vein from the inside, causing it to collapse.
EVLT is an alternative to foam sclerotherapy in some cases, as well as to other types of heat-based cauterization (ablation), such as using radio waves, and to surgical procedures requiring general anesthesia, such as removing (or "stripping") the vein or tying it off (ligation).
Both radiofrequency ablation and EVLT have been shown effective and with rates of complication that are lower than the surgical approaches.
In one study conducted at a hospital that used EVLT as its primary method of treating varicose veins, out of 319 patients studied, 96 percent achieved a satisfactory result (the vein closed up as expected). There were no burns and no cases of deep vein thrombosis (DVT), a potentially life-threatening condition that stems from a blood clot. Side effects in general were described as being "minimal."
