• 29 March 2018
  • Dr. Obinna Nwobi

Sclerotherapy vs. Endovenous Ablation: Which Is Better?

Varicose and spider veins can be unsightly, making your legs look years older. For most people, these veins are simply a cosmetic concern; others may experience discomfort or pain stemming from these blood vessels, and in rare cases they may indicate vascular disease.

Sclerotherapy and endovenous ablation are two common methods for dealing with varicose veins. The right choice for you depends on the nature of your particular condition. Each procedure has its own optimal use, and I will match the treatment to your condition upon diagnosis. Let’s look at the causes of varicose veins and how sclerotherapy and endovenous ablation work.

A pressure situation: How varicose veins form

Most commonly found in the legs and feet, varicose veins form due to loss of elasticity in the blood vessels. Veins return used blood to your heart and lungs, where it is re-oxygenated and sent out to the body again through your arteries. The veins of your legs work against gravity, pumping blood upward to your heart. Tiny valves in your veins help to prevent the backflow of blood, aided by muscle contractions in your legs.

As you age, the veins in your legs weaken and stretch, and the valves may no longer function effectively, permitting blood to pool, which forms the unsightly gnarls that show through your skin. People who spend long hours on their feet are typically more prone to developing a varicose vein condition.

Pregnancy also creates conditions that cause varicose veins due to changes in blood flow between the pelvis and feet that redirect more blood to the fetus. In many cases, pregnancy-related varicose veins may improve without medical treatment.

Spider veins are similar to varicose veins, but smaller and closer to the surface. These can be found in the legs and often in the face as well.

Clearing the problem: sclerotherapy and endovenous ablation

Your body can create new blood vessels to keep your cells vascularized, so treatment of varicose veins causes the veins to collapse, triggering new vein growth as well as removal of old vein tissue through your lymphatic system. Both sclerotherapy and endovenous ablation cause this collapse of varicose veins, but using different methods.

Also, sclerotherapy is best suited for small and medium veins, including spider veins, while endovenous ablation works better on medium to large varicose veins.

How sclerotherapy works

A substance called a sclerant is injected into a varicose vein. The sclerant may be either liquid or foam, and it irritates the vein walls and displaces blood from the target vein. This irritation causes the vein to collapse and ultimately disappear from your body.

Endovascular ablation

Inserting a laser fiber into the target vein, endovascular ablation uses light energy to warm the varicose vein. Once it reaches a certain temperature, collapse begins and the visible vein starts to fade from view as it’s flushed from the body.

The recovery

Both procedures are minimally invasive, and you can return to your normal daily activities immediately. There’s no scarring and one treatment is usually adequate for most patients, no matter which procedure is done. I may recommend compression stockings for the recovery period, as well as other general aftercare instructions, but otherwise there’s little you need to do as the treatments take care of your varicose veins.

About The Author

Dr. Obinna Nwobi

Dr. Obinna Nwobi is a board certified vascular surgeon, who chose to practice in an underserved area in Florida. In a field that graduates only 100 new vascular surgeons a year, Dr. Nwobi is an exemplary vascular surgeon who worked for the Indian Health Services, Veterans Affairs Hospital, and large private and public hospitals.


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