Treatment options:  The first is to eliminate any symptoms or medical conditions caused by venous disease; the second is to minimize recurrence of varicosities; and the third is to achieve the best cosmetic result.

Sclerotherapy is a procedure designed to decrease the visibility of unsightly spider or small varicose veins. During a sclerotherapy session, a chemical agent is injected into the abnormal vein using a tiny needle. This solution irritates the lining of the vein, causing it to collapse. The vein is then slowly absorbed by the body and eventually disappears.

Special wraps and elevation of the legs may be recommended to achieve the best cosmetic outcome. Downtime after sclerotherapy is minimal. Patients undergoing treatment may need to limit their sun exposure, minimize the use aspirin or anti-inflammatory medications, and avoid aerobic exercise for approximately 48 to 72 hours following treatment.

Side effects may include allergic reaction, ulceration of injection sites, slight stinging or burning during injection, and bruising which usually fades over the next month. Occasionally, there is some residual brownish pigmentation that will gradually fade. Pigmentation is minimized by wrapping, elevation, and massage.

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Surgical Treatment (minimally invasive)

Surgical techniques currently available for treatment of venous disease including stripping procedures (removal of the main superficial or outer leg veins), avulsion phlebectomy for removal of localized varicose veins, and transilluminated powered phlebectomy for removal of more extensive varicosities. All these procedures are performed on an outpatient basis and require only a few days of downtime following surgery. Because they are minimally invasive as compared to older surgical techniques, discomfort following the procedure is minimal. When necessary, stripping of the main outer leg vein is performed through two small incisions, one in the crease of the groin and one behind the knee. The vein is then gently removed by inverting the vein within itself and carefully peeling it away from its surrounding fatty tissue.

Endovenous laser ablation:  A small catheter is inserted into the vein under local anesthesia and the saphenous vein is obliterated without the need for surgery

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Avulsion phlebectomy is performed for the removal of localized regions of varicosities and is performed through many tiny, 1 mm incisions employing specialized instruments to allow the varicosities to be "teased" from beneath the skin.
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Transilluminated powered phlebectomy (Trivex Phlebectomy) is a technique whereby large regions of varicose veins can be removed with small incisions using techniques similar to liposuction.