CONSERVATIVE TREATMENT
The most common type of conservative treatment is wearing graduated compression stockings (tighter at the ankle than the thigh). Although such measures may not rid your legs of existing varicose and spider veins, symptoms associated with vein problems can be greatly improved by wearing support stockings. Conservative treatment is well suited for women who are pregnant or for those who are unable to undergo medical therapy due to advanced age or illness.

MEDICAL TREATMENT
For many people, merely slowing the progression of varicose or spider veins will not be enough. If you fall into this category, many corrective forms of treatment are available to improve both the cosmetic appearance of your legs as well as alleviate associated symptoms.

The first step, and likely the most important, is finding a physician with experience and expertise in phlebology, which is the field of medicine that deals with disorders of the venous system. In addition to a focused physical examination, additional evaluation utilizing a variety of diagnostic instruments may be necessary when determining the cause, severity and best treatment options available for your particular problem. These non-invasive diagnostic tests include doppler, duplex ultrasound and plethysmography.

COMPRESSION SCLEROTHERAPY
Sclerotherapy involves a series of injections using a tiny needle to administer small amounts of a solution into the vein. The sclerosant irritates the inner lining of the vein causing it to collapse and ultimately disappear. Sclerotherapy is performed as an in-office procedure and should cause only minimal discomfort. Following treatment, you can return to your normal daily activities. Elastic bandages or support stockings may need to be worn during the daytime for a few days, which will aid in the closure of your veins.

ENDOVENOUS LASER (EVLT)
Recently, a novel technique using laser energy delivered within the vein via a small laser fiber has been developed for the treatment of varicose veins with excellent preliminary results. Compared to surgery, the potential advantage of endovenous laser treatment is a minimally invasive technique performed in the office with little to no scarring and a shortened recovery period. Compared to existing minimally invasive techniques, endovenous laser treatment may allow for more precise control of vein wall damage, resulting in lower recurrence rates and less potential for adverse side effects.

DUPLEX ULTRASOUND-GUIDED SCLEROTHERAPY
Occasionally, patients with more severe varicose veins will need further therapeutic intervention. In the past, surgical ligation and stripping was the only treatment available for these cases. Today, minimally invasive in-office methods are available and offer good alternatives to surgery for many people. One such technique is duplex ultrasound-guided sclerotherapy. In experienced hands, duplex ultrasound-guided sclerotherapy is highly effective, very safe and painless.

SURGICAL LIGATION AND STRIPPING
Surgical removal (also called ligation and stripping) of the greater saphenous vein (the main superficial vein of the leg) may be necessary in some patients with large varicose veins. This procedure is usually performed under general anesthesia, although local or spinal anesthesia may be used. When properly performed, the greater saphenous vein is removed from the groin to the knee through small (usually two) incisions using a special instrument.

AMBULATORY PHLEBECTOMY
Ambulatory phlebectomy is a minor surgical procedure that can be used to remove some large varicose veins. This procedure can be performed in the office using local anesthesia. The veins are removed in segments through tiny incisions. No stitches are necessary and scars are barely visible in most cases.

LASER THERAPY
A variety of laser and light source therapies are currently available. Although many lasers have been highly effective in the treatment of facial spider veins, laser treatment of spider veins on the legs has proven to be more challenging. Currently, compression sclerotherapy remains the treatment of choice for removing most unwanted leg telangiectasia, with lasers offering a complementary treatment modality in only a select group of people.

THE TREATMENT OF CHOICE
The treatment of choice for the majority of varicose veins and nearly all spider veins on your legs will be compression sclerotherapy. In some cases, additional intervention such as surgery, duplex ultrasound-guided sclerotherapy or endovenous laser treatment will be necessary. Often, a combination of the above treatments will be most beneficial.