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Which Spider Vein or Varicose Vein Treatment Is Recommended by the Top Doctors?

Our Vein Treatment NYC Vein Experts Rank the Options.

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Do you want to get rid of spider veins or varicose veins but don’t know the best way to do it?

Read on to see what the top vein doctors in NY state think about the various treatment options. You’ll learn the upsides and downsides of each method so you can make the right decision. You’ll also learn why it’s so important to choose the right vein doctor in New York City, and how to make that choice. Let our experts take the guesswork out of the process so you can skip straight to the results.

If your parents described their vein treatment, you might be hesitant to follow in their footsteps. Vein treatment in prior generations was often unpleasant, particularly the surgical stripping method. But minimally invasive vein care has revolutionized the process in the last 30 years, outpacing all other fields in advancements. There is now a multitude of safer, gentler options, which is great news but also confusing for patients. How do you know which one to choose? The answer depends on variables like your symptoms, overall health, and preferences. Our vein doctors in Manhattan are here to help! Let’s look at each method up close to determine which one is best, and which doctor is best suited to perform it.

First, it’s essential to understand why spider veins and varicose form, since that’s a big piece of the treatment puzzle. Damaged veins at the surface of your skin might result from a problem below the surface, called venous insufficiency. This condition impairs the circulation of blood from the legs to the heart. Weak valves in leg veins allow blood to pool or regress, rather than progressing away from the feet. Pressure accumulates in the veins, prompting varicose vein or spider vein formation. If your doctor fails to identify this condition, the problem continues and often becomes chronic. Choose a vein doctor who determines the cause to achieve lasting results.
Our vein centers in Midtown and FiDi Manhattan treat venous insufficiency comprehensively, eliminating the problem and the symptoms.

Vein Treatment Options

Endovenous
Ablation

Also known As: Radiofrequency ablation, ablation, laser ablation
Best For: Big varicose veins, chronic venous insufficiency, and symptoms like heaviness, fatigue, cramping, restlessness, and pain.

What Is Endovenous Ablation?

Leg veins are supposed to route deoxygenated blood toward your heart to retrieve oxygen. If a valve fails inside these veins, blood accumulates in the veins or flows in reverse. As pressure builds in the veins, they develop varicosities, known as varicose veins, or branch out into the telangiectasias known as spider veins. Endovenous ablation uses heat to close these abnormal veins, typically found just below the skin’s surface.

How Does Endovenous Ablation Work?

A safer, gentler, and more cost-effective solution than surgical stripping or ligation, endovenous ablation is a quick and minimally invasive way to treat large, damaged veins and venous insufficiency. Our vein doctors in NYC numb the skin above the vein, and also surround the vein with a numbing solution for optimal comfort. We then insert a small device into the vein that delivers the perfect amount of heat through radiofrequency (RF) or laser (EVLT) energy to close the vein. Destroying these veins has no detrimental impact, as the blood is then re-routed to vital veins that facilitate blood circulation. The sealed veins are then scarred shut and absorbed by the body. Ablation has tremendous advantages over surgery and should be the first line of treatment at any vein center in NY state. It takes just 15-30 minutes and is performed in-office, typically while you’re awake. Patients can head back to work or resume activities immediately following the procedure. Ask our vein specialists in Manhattan about RF ablation and laser ablation, and why we tend to prefer RF. We’ve performed countless ablative procedures and love providing answers to your questions.

Pros

Considerably safer, cheaper, and more efficient than surgery, radiofrequency ablation is highly effective against vein disease. It eliminates downtime and has a 10-year safety record. Insurance often covers ablation, which is one more reason our vein doctors in NY state recommend this method.

Pros Summary:
  • Eliminates downtime
  • Less invasive, yet more effective than surgery
  • Most patients receive insurance coverage
  • Safer and gentler than stripping or ligation

Cons

Results of endovenous ablation vary based on the machine used and the doctor’s level of training with the machine. The method’s popularity led to the manufacture of machines of varying quality. Always choose a reputable vein doctor with extensive experience in ablative therapy. Since the procedure involves a precise application of tumescent anesthesia around the vein walls, you need a doctor with a trained hand to prevent discomfort. The experts at New York Vein Center are distinctly trained in ablative procedures and use only state-of-the-art machines.

Cons Summary:
  • Trained hand and precision required
  • Machines vary in quality, affecting results
  • Tumescent anesthesia can cause swelling

Is Endovenous Ablation a Good Option for You?

Endovenous ablation is one treatment our vein doctors in NY state prefer (particularly RF ablation, since it’s more comfortable than laser ablation). The safety profile, convenience, and insurance coverage make it an excellent choice for most patients.

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VenaSeal

Also known As: Vein Glue
Best For: Venous insufficiency and accompanying symptoms like discomfort, leg fatigue, achiness, cramping, and a restless feeling in the legs.

What Is VenaSeal?

Recently introduced by the reputed scientists at Medtronic, VenaSeal employs cyanoacrylate glue to seal damaged veins shut, instead of thermal energy. Long used by doctors in other procedures, it boasts an established safety profile, prompting its implementation in vein disease treatment.

How Does VenaSeal Work?

This new technology uses ultrasonography to find problematic veins. Our vein doctors in NYC numb the desired entry point on your leg and deliver a small amount of medical-grade glue through a catheter to the vein. The ultrasound assists the doctor in the positioning of the tip that releases the cyanoacrylate into the vein. Once the vein glues itself together, the solution hardens and the vein is absorbed by the body, thereby directing blood flow to veins that are working correctly.

Pros

There is no swelling with VenaSeal, since tumescent anesthesia is not needed. The cyanoacrylate travels into branches of veins, potentially sealing several defective offshoots with a single application.
Pros Summary:
  • Cutting-edge procedure
  • Travels to multiple diseased branches
  • New option for veins subjected to prior treatments

Cons

VenaSeal is quite new, which means we don’t know the impact over the course of a patient’s lifetime. Certain patients might be allergic to the glue. Some patients don’t like the thought of the glue hardening and staying in their body. Only certain insurance carriers cover VenaSeal, so the price varies by patient.
Cons Summary:
  • New technology, lifetime impact unclear
  • Few insurance companies cover VenaSeal
  • Glue stays in the body
  • Certain patients have allergic reactions

Is VenaSeal a Good Option for You?

VenaSeal should be considered by patients who have treated their veins before. Ask your doctor to test your allergic propensity prior to injecting VenaSeal. Ask our insurance specialists if VenaSeal is covered by your provider so your procedural costs are clear.

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Sclerotherapy

Also known As: Saline injections, cosmetic sclerotherapy, STS, salt solution injections.
Best For: Small varicose veins or spider veins

What Is Sclerotherapy?

This technique injects an irritant directly into the affected vein. The sclerotic substance causes the vein’s collapse, making it smaller and lighter. Once closed, blood can no longer flow into the vein, so it begins moving in the right direction again.

How Does Sclerotherapy Work?

Our vein doctors in Manhattan check for spider veins and varicose veins at the surface and use ultrasound machines to detect deeper problematic veins. We then insert a small needle into the vein, using ultrasound guidance as needed, and inject a sclerosant that irritates the vein lining, causing it to cave in and shift blood flow into thriving veins. Doctors can use different medicines as irritants, including hypertonic saline, one of the original salt-water sclerotic solutions. But our doctors use the newer sclerosants which are much more comfortable for patients.

Pros

The liquidity of sclerosants allows them to circumnavigate the tortuosity of varicose veins. The catheter used in endovenous ablation can’t target those twists and turns. In addition to navigating varicose veins, sclerotherapy also treats saphenous spider veins quickly and easily.
Pros Summary:
  • Quick and effective resolution of spider veins
  • Navigates tortuous veins better than ablation

Cons

Doctors can choose from a variety of sclerotherapy options that vary in price and efficacy. Each type has certain pros and cons, and even different formulations. Many liquid sclerosants must be diluted for proper dosing. The right dose varies by patient, and some doctors aren’t trained in accurate dosing. If a vein doctor uses substandard medicine or doesn’t mix it correctly, patients can experience pain and discoloration of their skin. A more serious complication, called necrosis, occurs when the doctor mistakenly injects muscles or arteries instead of the vein. That’s why it’s important to choose a qualified vein center like New York Vein Center for sclerotherapy.
Cons Summary:
  • Requires a board-certified doctor to avoid complications
  • Quality of sclerotic solutions varies

Is Sclerotherapy a Good Option for You?

Sclerotherapy is an excellent solution, particularly if ablation and VenaSeal aren’t options for you. Sclerotherapy is also advised for patients without venous insufficiency who want to reduce the visibility of superficial veins.

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Foam Sclerotherapy

Also known As: Vein injections, foamed sclerotherapy.
Best For: Large varicose veins and small varicose veins.

What is Foam Sclerotherapy?

Foam sclerotherapy also closes damaged veins, with a few distinct advantages over liquid sclerotherapy. When liquid sclerosants enter the vein, they’re diluted by blood. In contrast, foam displaces the blood, coating the walls of the vein directly. As such, a lower concentration of medicine can be used to treat the vein. Additionally, liquid sclerosants can produce four to five times their volume when agitated to form gas bubbles. Most sclerosants are detergents that foam up nicely when mixed with air. The vein expert can fill a larger vein using less medicine when it’s converted to foam, keeping dosages low. Foam is also easier for vein specialists to track, which enhances efficacy.

The Procedure

Doctors locate the vein, often through ultrasound, and prepare the skin for injection. Since bubbles begin to dissipate quickly, trained doctors know to mix the foam immediately before injection by passing the sclerosant rapidly between two syringes. Once the foam is inside the vein, your doctor will watch its movement via ultrasound to ensure it fulfills its duty.

Pros

Foamed sclerosants are impressive at reaching tight spots in tortuous veins. Foam therapy is also a valuable tool for patients whose veins have been treated before.
Pros Summary:
  • Superior movement through twisted veins
  • Gentle solution for chronic vein disease

Cons

Foam is so adept at moving through veins that it can travel into connected perforating veins if the doctor doesn’t map out your venous connections. It’s critical to keep the foam out of these deeper veins, so an experienced physician, like our New York vein doctors, will always look for these connections before they inject the foam.
Cons Summary:
  • Risk of damaging deeper veins if connections aren’t assessed

Is Foam Sclerotherapy a Good Option for Me?

If your varicose veins or reticular veins (smaller and less raised, but still ropy and visible) are bothering you, foam sclerotherapy is an excellent cosmetic solution. But it’s also advantageous for veins that have been treated with other methods, and for the underlying venous insufficiency that causes them.

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Pre-Mixed Foam Sclerotherapy

Also known As: Foamed Sclerotherapy.
Best For: Big varicose veins, chronic venous insufficiency, and symptoms like cramps, achiness, heaviness, swelling, and fatigue.

What Is Pre-Mixed Foam Sclerotherapy?

This technology enhances foam therapy by eliminating potential for error in the agitation process. Sometimes foam sclerosants cause air embolisms which impair the oxygenation and travel of blood, when mixed with air in the room. Pre-mixed foam arrives at the doctor’s office in a sealed canister already prepped for injection with the ideal combination of CO2 and nitrogen to eliminate embolisms. This formula accelerates the foam through the bloodstream, deactivating it rapidly to optimize results and safety.

How Is Pre-Mixed Foam Sclerotherapy Performed?

Once your doctor has isolated the defective vein, they’ll inject the pre-mixed foam through a tiny needle or through an ultrasound device if the vein is a bit deeper. Rather than agitating the liquid irritant to create foam, the doctor injects the pre-made foam from the storage canister.

Pros

Pre-mixing the foam makes it extra effective, particularly for recurrent vascular disease. When performed by a trained vein doctor, it’s a safer, gentler, and faster alternative to surgery.
Pros Summary:
  • Extremely effective
  • Safer, quicker, and less invasive than surgery
  • Powerful against recurrent vascular disease

Cons

The formulation of pre-mixed foam is highly potent, so it requires more experience than other methods. This newer version of sclerotherapy isn’t always covered by insurance, so it’s important to choose a vein treatment that determines your coverage before treatment.
Cons Summary:
  • Its potency demands expert precision
  • Your insurance plan might not include it

Is Pre-Mixed Foam a Good Option for Me?

Pre-mixed foam sclerotherapy is not only a safe and powerful alternative to other forms of sclerotherapy, but it’s also advised over surgery for some patients. While this procedure is costly, if your insurance plan covers it, it’s more affordable than surgery.

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ClariVein

Also known As: Mechanochemical Ablation.
Best For: Treating the underlying cause of spider veins and varicose veins (venous insufficiency) as well as relieving discomfort, leg fatigue, cramps, heaviness, and restless legs.

What Is ClariVein?

This technology delivers a “one-two punch” to the vein, first inducing mechanical trauma to the vein wall, then following that with a sclerosant to induce venous closure. ClariVein administers this technique through a small catheter with a rotating fiber that delivers both types of damage to destroy the unhealthy vein.

How Is ClariVein Performed?

Once your doctor has cleaned the area and located the vein through ultrasound, they will numb the skin where the catheter will enter. The device is directed into the vein, where it begins to rotate and then secrete a sclerosant, both of which traumatize the vein. In contrast to radiofrequency ablation and sclerotherapy, ClariVein uses two modes of action to enhance results.

Pros

ClariVein doesn’t leave an implant behind like VenaSeal. It does not use the tumescent anesthesia required in ablative therapy. The small catheter can access twisted veins.
Pros Summary:
  • No swelling from tumescent anesthesia
  • No implant remains in the body
  • Small fiber reaches tortuous areas

Cons

Sometimes complications occur with ClariVein when a doctor can’t easily move the catheter through a valve in the vein. This can be very uncomfortable. Also, insurance companies don’t always pay for ClariVein.
Cons Summary:
  • Insurance might not pay for ClariVein
  • Discomfort possible when passing through venous valves

Is ClariVein Right for Me?

If you’re allergic to lidocaine, or uncomfortable with the thought of glue in your body, you might prefer ClariVein over RF ablation or VenaSeal. Be sure to ask your doctor about insurance coverage and about how to achieve good results with ClariVein.

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Surgery

Also known As: Vein ligation, vein stripping, phlebectomy.
Best For: Larger varicose veins

What Is Vein Stripping?

Vein stripping exposes the diseased vein through an open incision in the leg, whereby the doctor uses surgical tools to extract it.

How Is Vein Stripping Performed?

After ultrasonography locates the vein, the patient is given general anesthesia and taken to an operating room. A vein doctor will perform a “cut down” into the skin above the vein, so they can locate it firsthand. The surgeon will then pull the entire length of the vein from the body (stripping), commonly with a hook, or cut away a portion (ligation), and then stitch your incision closed.

Pros

For patients with the largest, most tortuous veins, or with a history of blood clots, surgery might be the best choice.
Pros Summary:
  • In limited cases, there’s no alternative to surgery.

Cons

Surgery presents more complications and is more painful, costly, and time-consuming than minimally invasive solutions which don’t require any recovery time. The doctors at New York Vein Center don’t recommend surgery unless it’s the only choice.
Cons Summary:
  • Minimally invasive solutions supersede surgery in many ways for most patients.

Is Vein Surgery Right for Me?

Doctors might recommend surgery for patients with blood clots. But in general, our vein doctors in NYC don’t suggest surgical stripping unless all other methods have failed or your vein is too torturous to be treated with other techniques.

It’s important for patients to understand the causes, symptoms, and treatments of spider and varicose veins to achieve lasting relief. If you’d like to know more, contact the vein specialists at New York Vein Center with your questions. Our board-certified doctors are as skilled at educating patients as they are at administering treatment.

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Do you have questions about the vein treatments we’ve discussed?

It’s important for patients to understand the causes, symptoms, and treatments of spider and varicose veins to achieve lasting relief. If you’d like to know more, contact the vein specialists at New York Vein Center with your questions. Our board-certified doctors are as skilled at educating patients as they are at administering treatment.

So How Do You Know Which
Vein Treatment Option Is Best for You?

Deciding which vein treatment to try is confusing for most patients. Choose a qualified doctor at an accredited treatment to help you make the right choice. You deserve a doctor who will customize your treatment plan, combining techniques if needed. Don’t begin treatment without first determining whether your doctor is qualified to treat you. Here are five things to require of your chosen provider:

1

The vein doctor hears and answers your questions:

1

The vein doctor hears and answers your questions:

It’s surprising how many patients feel their doctor doesn’t listen to them. Some vein treatment schedule doctors in such tight blocks that they don’t have time to really listen. This is not only frustrating for patients, it’s also dangerous. At New York Vein Center, we want to know everything about your symptoms, concerns, and medical history to devise the best treatment plan. We take time to get to know each patient and answer every question.
2

The vein center investigates beneath the surface:

2

The vein center investigates beneath the surface:

Some veins, like spider veins, seem like a cosmetic issue. But a top vein doctor knows to check for underlying problems like venous insufficiency. Finding the source of the problem is key to preventing those veins from appearing over and over again.
3

The vein specialist is proficient in ultrasonography:

3

The vein specialist is proficient in ultrasonography:

Few vein centers receive the distinction our vein centers in Manhattan (Midtown and Fidi), and Hartsdale holds. As a double-accredited vein center, we’re exceptionally qualified to conduct both vascular imaging and vein treatments. Following the most rigorous accreditation process, we’ve been recognized for remarkable care and safety standards.
4

The vein center is fully accredited:

4

The vein center is fully accredited:

Only the best vein centers in NYC receive recognition from the intersocietal accreditation commission, or IAC. This stamp of approval is evidence of New York Vein Center’s superior quality and safety standards, as well as the quality of our doctors and equipment.
5

The vein treatment plan is tailored to you:

5

The vein treatment plan is tailored to you:

Vein health, vein connections, and vein symptoms vary widely between individuals. Vein doctors should customize the treatment plan to fit your unique circumstances. There is no single treatment that’s right for everyone, even if they have the same vein disease. Our vein specialists in Manhattan take time to design the best plan to restore your venous health, considering your opinions, preferences, and concerns throughout the process. We can even combine multiple methods to achieve your desired results. We take care to keep patients completely informed, every step of the way.

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