If you have varicose veins, you will most likely start your treatment plan with conservative treatments like compression therapy to see whether this makes a difference in your vein health. However, if after a few months, your varicose vein symptoms have not improved, it may be time to move on to other treatment options.
Dr. Jerry Ninia has been in the industry for more than 30 years and has seen treatments for varicose veins come and go. Today, he builds his practice, Varicose Vein Center, on treatments that provide the best results for his patients while also minimizing the time they have to spend in recovery.
Three of the options that may be presented to you during your consultation are Varithena, sclerotherapy, and ambulatory phlebectomy. The right option for you will depend on the size and severity of your varicose veins, along with many other factors.
Why There Is No Single Best Varicose Vein Treatment
Every vein affected by reflux is different. Some are thin, flat, small or close to the surface. Others are large and twisted or deeper in the leg. Treatments that are suitable for smaller varicose veins or spider veins will not be effective on a bulging saphenous vein. Dr. Ninia’s approach starts with a diagnostic ultrasound so he can get a more accurate picture of what is happening beneath the skin, including any hidden venous reflux issues that are causing your bulging veins.
Treating Smaller Veins With Sclerotherapy
Sclerotherapy is one of the longest-standing treatments in vein medicine, and has a good track record for effectiveness when used on the right type of vein. During sclerotherapy, a liquid sclerosant is injected into the problem vein in order to irritate it and cause a collapse. In the weeks or months after the treatment, the body gradually absorbs the problem vein.
What Types of Veins Does Sclerotherapy Treat Well?
This treatment is the gold standard when we are treating spider veins, but it can also be used for certain varicose veins, especially when they are small in size. If you have larger varicose veins, we will recommend different types of treatments. For the right veins, sclerotherapy provides high patient satisfaction rates. Treated veins face at least 70% after just one treatment, in Dr. Ninia’s experience.
Treating Hard-to-Reach Veins With Varithena
Varithena has taken the principle of sclerotherapy and adapted it for veins that liquid solutions cannot adequately treat. The medication is a microfoam rather than a liquid, and it expands to fill larger vessels after Dr. Ninia injects it. The foam maintains contact with the vein wall long enough to cause it to collapse and eventually seal shut. The foam displaces the blood rather than being diluted by it, which makes it more effective for certain veins.
When Is Varithena the Right Choice?
Varithena is FDA-approved for varicose veins caused by venous insufficiency in the great saphenous vein system. It tends to work well for veins that are twisted (tortuous) or difficult to reach with treatments that use a catheter, like endolaser therapy. Varithena also uses no heat, so it can be a good option for those who are concerned about thermal irritation.
Clinical Evidence for Varithena
The FDA approved Varithena based on the VANISH-1 and VANISH-2 clinical trials, which enrolled hundreds of patients. Both trials showed an improvement in symptoms and vein appearance compared to a placebo. Only about 3% of treated veins required retreatment.
Removing Veins With Ambulatory Phlebectomy
Ambulatory phlebectomy is a minimally invasive technique with less discomfort and downtime than outdated vein stripping methods. With this method, Dr. Ninia makes tiny punctures in the skin just a couple of millimeters wide and then extracts the vein. While older methods required weeks of downtime, you can return to all of your usual activities the same day with very little fuss.
What Types of Veins Are Good Candidates for Removal?
Phlebectomy is often best for large veins that are bulging at the skin’s surface. These veins are visible, but too large to be treated with other methods. After Dr. Ninia removes them, there is an immediate improvement in the symptoms of the varicose veins since the vein is gone rather than being slowly absorbed by the body.
How These Treatments Compare Side by Side
| Sclerotherapy | Varithena™ | Phlebectomy | |
| Best For | Spider veins, reticular veins and small varicose veins | Large, twisting or deep truncal veins | Bulging surface veins visible through the skin |
| How It Works | Liquid sclerosant is injected into the vein to collapse it | Microfoam fills and seals the vein under ultrasound guidance | Veins physically removed through tiny punctures |
| Uses Heat | No | No | No |
| Anesthesia | None or local | Local | Local |
| Typical Sessions | Multiple sessions possible | Usually one session | One session |
| Return to Activity | Same day | Same day | Same day to next day |
| Insurance Coverage | When medically necessary | When medically necessary | When medically necessary |
Why Dr. Ninia Often Combines Vein Treatments
When there are underlying venous concerns, more than one type of vein can be affected. Sometimes Dr. Ninia may use a method like Varithena or endolaser therapy to close the source of the reflux first, and then follow up with sclerotherapy or other treatments to treat residual veins. Because he performs all of these treatments himself in the office, you will stay under one doctor’s oversight from start to finish.
What to Look for When Choosing a Vein Specialist
Board certification in phlebology means that the physician has been tested specifically on venous disease. Dr. Ninia holds double board certification in phlebology and OB/GYN. He is also a Registered Vascular Technologist who performs his own diagnostic ultrasounds, so you get all of your care from the same provider. He has also authored textbook chapters on sclerotherapy and venous disease, and delivers lectures internationally, so other physicians regularly learn from him.
Your Next Step Toward Fewer Symptoms
The right varicose vein treatment always starts with an accurate diagnosis. There is no way to know which of these treatments is best for you until Dr. Ninia has a chance to examine your veins and perform an ultrasound. At Varicose Vein Center, we look forward to helping you improve your vein health. To get started, call 631-474-1414 or request your consultation online.
