It is the general consensus among phlebologists (=leg vein treatment experts) that 95% of leg veins should be treated with sclerotherapy first, because it is safe, effective and affordable. Large varicosities can be surgically treated with a variety of vascular procedures including stripping, endovenous radio-frequency or laser ablation.
Sclerotherapy involves the injection of a sclerosing agent into the veins via a very fine needle. All sclerosing agents are comfortable when injected, except for hypertonic saline which is reserved for the most resistant vessels only.
A compression dressing is applied immediately after treatment and kept on for a few days. Exercising can be resumed within days to weeks depending on the size of the vessels treated.
Sclerotherapy generally clears 80% of the treated veins. Multiple sessions may be necessary. 20% of patients can develop neovascularisation, which are clusters of smaller new vessels which require further treatments. Some patients develop temporary brown discolorations due to the iron deposits from the old vein. These can take months to clear.
Small resistant vessels or needle-phobic patients can be treated with a long pulse ND:YAG laser such as Cynergy Multiplex or an alexandrite laser such as the GentleLase.
Sclerotherapy is best done in the fall and winter, but patients invariably show up in the spring before bathing suit season!.