Advantages and disadvantages of chronic venous insufficiency treatment methods

Long-pulse laser
According to Dr Phan Duy Kien, who works in the department of vascular and endovascular surgery at Cho Ray Hospital, long-pulse lasers are only suitable for treating grade 1 superficial dilated veins like spider veins or telangiectasias (diameter smaller than 1 mm).
This method is ineffective for varicose veins from grade 2 onwards as it cannot affect the deep venous system, located 1-2 cm beneath the skin and the main cause of saphenous vein insufficiency.
With their wavelength of 1,064 nm, long-pulse lasers only affect blood vessels close to the skin’s surface (3-4 mm deep).
Patients often mistakenly believe that the disappearance of spider veins or telangiectasias means they are no longer suffering from varicose veins.
But this is merely a superficial improvement.
Sometimes varicose veins are caused by insufficiency of the venous structure located deep under the skin (saphenous veins, perforator veins and deep veins).
If the diagnostic process is incomplete, ultrasound might not detect the issue, leading to the use of long-pulse lasers solely to treat surface symptoms while neglecting the root cause, causing a recurrence of varicose veins.
Sclerotherapy
Sclerotherapy is the method of injecting a sclerosing solution directly into the vein, causing it to close and eventually fade.
According to Dr Phan Duy Kien, like long-pulse lasers, sclerotherapy should only be used to treat C1 chronic venous insufficiency and is especially recommended for reticular veins rather than spider veins (telangiectasias).

Sclerotherapy for the treatment of reticular veins. Photo courtesy of Dr. Vein

Dr Kien explains that the ideal diameter for sclerotherapy is 1-3 mm (reticular veins).
For very small blood vessels like spider veins, attempting to inject them can lead to drug leakage, where the sclerosing solution spills outside the blood vessel, causing necrosis of the skin and subcutaneous tissue.
Therefore, sclerotherapy requires practitioners to have specialized training and extensive experience to prevent complications.
In grade 2 superficial varicose veins, the cause is often saphenous vein insufficiency with a relatively large diameter of over 5 mm or even exceeding 10 mm.
With this size, sclerotherapy may not fill the entire vein with the solution, reducing the effectiveness of sclerosis.
The vein may not be completely closed, which poses a high risk of recurrence.
In particular, sclerotherapy is contraindicated for patients with deep vein thrombosis as it can lead to death.
“Therefore, thorough vascular diagnosis is crucial to identifying the exact cause and potential risks, minimizing complications and risks during treatment,” Dr Kien said.
Dual cool laser
Traditional long-pulse lasers used in treating spider veins can sometimes cause heat-related side effects such as redness, blisters and changes in skin pigmentation.
However, the innovative Dual Cool Laser revolutionizes this treatment.
Its dual cooling system, combined with precise laser intensity adjustments by a vascular specialist, significantly minimizes the risk of burns, ensuring a more comfortable patient experience.
Beyond improved safety, the Dual Cool Laser also offers numerous advantages like non-invasive treatment, reduction of melasma and dark spots, effective treatment for dilated capillaries and spider veins, and reduced side effects.

Results after treatment with Dual Cool Laser. Photo courtesy of Dr. Vein

Sclaser
Sclaser is a cutting-edge chronic venous insufficiency treatment that combines the best aspects of laser therapy and sclerotherapy.
This innovative approach is particularly effective at treating both spider veins and reticular veins simultaneously.
Research published in the American Journal of Venous and Lymphatic Medicine demonstrates that Sclaser outperforms sclerotherapy alone, effectively eliminating damaged veins and minimizing the risk of recurrence and unwanted side effects.
What sets Sclaser apart is its ability to prevent drug leakage, a common issue with sclerotherapy on small veins.
It also offers the advantage of treating both reticular and spider veins in a single session, reducing the need for multiple treatments and eliminating the need for refills.
Patients experience immediate improvement after the procedure, with no downtime required.

Results after treatment with Sclaser. Photo courtesy of Dr. Vein

While Sclaser represents a significant advancement in chronic venous insufficiency treatment, Dr Kien emphasizes the importance of seeking treatment from experienced vascular and endovascular surgeons to avoid cases of old methods disguised as new ones and incorrect treatment causing complications besides ensuring optimal results.
Dr Kien also spoke about “compression stockings,” a self-treatment method at home for varicose veins.
Compression stockings (medical stockings) are a fundamental treatment method, helping improve blood circulation and reduce pressure on the vein walls, thereby preventing the progression or recurrence of the condition.
“Besides incomplete diagnosis and treatment, varicose vein recurrence is also caused by patients not adhering to treatment, especially wearing compression stockings,” he said.

Dr. Phan Duy Kien and Dr. Le Kim Cao perform varicose vein treatment at Dr. Vein. Photo courtesy of Dr. Vein

Regardless of the treatment method applied, the correct diagnosis of the cause and strict adherence to the doctor’s instructions by the patient still play an important role in helping thoroughly treat varicose veins and prevent recurrence, he added.

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