Varicose and Spider Veins

If you have painful swelling in your legs, varicose veins, or leg ulcers, it may be due to varicose or spider veins. Either condition can be very painful and may affect your day-to-day lifestyle. Mount Sinai provides comprehensive and personalized care for vein disease. Our experts offer complete care, from setting up an appointment for initial evaluation to scheduling tests like a Duplex scan. We will develop a tailored plan that best suits your needs. We have all the latest devices to treat these conditions.

About Varicose Veins and Spider Veins

Venous insufficiency means that your leg veins are not doing a good job of transporting blood back to your heart from around the body. This condition usually stems from a problem with valves in the vein that normally help move the blood from the leg to the heart. The role of the valves is to prevent back flow (reflux) in the leg. But if the valves aren’t working well, it can cause blood to pool in your legs, which can lead to leg venous blood congestion.

You are more likely to experience varicose or spider veins if you are obese, pregnant, have a prior history of clot in the legs, or have a history of trauma to the leg or leg surgery. Other risk factors include:

  • Advanced age
  • Being tall
  • Inflammation and swelling of the superficial veins (phlebitis)
  • Sitting or standing for a long time
  • Smoking
  • Women (due to the hormone progesterone) 

Diagnosis and Treatment

Vein specialists usually begin diagnosis of varicose and spider veins by taking a thorough history and conducting a physical examination. If we think you need additional testing, we may perform a Duplex ultrasound. This office-based, non-invasive test shows us the blood flow in your veins and allows us to determine how much reflux you are experiencing.

In the Division of Vascular Surgery, we offer several venous treatment options. Whenever possible, we recommend conservative treatments, such as:

  • Avoiding long periods of sitting or standing
  • Caring for wounds and ulcers
  • Losing weight if you are overweight
  • Taking diuretics (fluid pills) to decrease leg swelling
  • Wearing compression stockings

In some cases, we may need to perform a minimally invasive or open surgical procedure.

Minimally invasive procedures have more than a 90 percent success rate and we perform them in our office without anesthesia. Treatment options available include:

  • Endovenous thermal ablation is often the treatment of choice. We introduce a narrow tube (catheter) into your vein under local anesthesia, then use radiofrequency (RFA) or laser (EVLT) technology to burn and harden the vein from inside. Eventually, the veins disappear and the disease is gone.
  • Sclerotherapy involves injecting chemical agent into your veins, which hardens the vein and makes the disease disappear over time.
  • Stab phlebectomy is a less common approach. We make small cuts over the dilated veins and then remove the veins through these incision sites.

We can also perform traditional open surgery to treat venous insufficiency, if necessary. These procedures include:

  • Vein stripping involves removing the veins from under the skin, under anesthesia.
  • Ligation of veins means tying the vein at its origin, usually the groin.