Varicose veins are an abnormal dilation of the vein due to leaking valves or proximal venous obstruction. It may be hereditary or job related. Untreated varicose veins may cause phlebitis, massive bleeding or skin ulcers.

There are 3 main procedures/options for the treatment of large varicose veins:

• Traditional or old-fashioned way which is vein ligation and stripping - This procedure requires general or spinal anesthesia. It may cause massive bleeding, nerve injury, and may leave many ugly scars on the leg. The patient will need one week off from work. This is not the procedure of choice.
  
  
• Modified or alternative way which is vein ligation and sclerotherapy - This is a better choice due to the simplicity, safety, and effectiveness of the procedure. This procedure can be done in the office under local anesthesia. The patient may return to work the same day and resume normal activities with no down time. This is a minor office procedure, but it can achieve the best cosmetic results.
  
  
• Advanced and modern technique of venous closure - This is the state of the art treatment for varicose veins. Under ultrasound guidance, a closure catheter is positioned inside the diseased vein with the leaking valve through a small skin opening above the knee area. The tiny catheter delivers radio frequency (RF) or laser energy to the vein wall. As the RF or laser energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the vein wall to shrink and the diseased vein to close. This procedure requires an additional ambulatory phlebectomy or sclerotherapy for the existing varicose vein three days after the closure procedure.
  

Spider veins are mild abnormal veins. Most of them are asymptomatic but sometimes may cause burning pain.

There are 3 main procedures/options for the treatment of spider veins and small varicose veins:

• Sclerotherapy - Using a tiny needle, the sclerosing agent is injected into the varicose vein and/or spider vein. This will cause the vein to close, become fibrosis, and the patient’s body will absorb it, making it disappear.
  
  
• Ambulatory phlebectomy - Under local anesthesia, a tiny stab wound is made next to the varicose vein. A special hook is used to pull out the varicose vein. This procedure will leave only a tiny scar which is almost invisible.
  
  
• Laser procedure - There are certain limitations to laser treatment. Laser only works when the vein size is 2 mm or smaller. The first choice of treatment for spider veins is sclerotherapy. For very tiny spider veins, unable to be treated by sclerotherapy, laser can be very helpful.