Outpatient Treatment of Varicose and Spider Veins


Those unsightly varicose veins and spider veins—what to do about them? The physicians of Vascular Surgery Medical Group have the solutions and the technology to treat those conditions quickly and safely. They talk about some of the more popular and effective options.


What causes varicose veins or spider veins?

It’s usually a valve dysfunction—the little valves that keep the blood flowing upstream. That’s what leads to those bulky, unsightly veins that are sometimes painful.


What should someone do if they want to get rid of them?

Once you find a professional physician who has a lot of experience dealing with this, you can discuss what the various options are. Frequently, ultrasound is required to evaluate valve function and to see if there’s an underlying cause. But for many spider veins, it’s just surface veins that we see. And those can be treated in a few different modalities—most of the time with sclerotherapy, which consists of small vein injections with a tiny needle to get rid of the surface spider veins. That can be done with minimal discomfort in the office. Not much down time, just wear some stockings for a few days. Over the course of a couple of months, those will generally fade away quite nicely.


What are some common misconceptions about varicose veins and spider veins?

One of the common misconceptions we hear is that varicose veins and spider veins are dangerous or life-threatening, which is generally not the case. Another common misconception is that the surgery is very painful. It’s not.


How is this surgery different from the way it was a generation ago?

Things have become less invasive. Traditionally, these procedures required open surgery in a hospital to strip out the veins and remove entire lengths of veins in the thigh or calf. We don’t do that anymore. We often do a procedure called a vein ablation, either laser or radiofrequency, where we seal off somebody’s branches comfortably with just a needle puncture and a couple of injections of local anesthesia. That’s a major change. We haven’t done an open surgical operation for veins in a hospital in quite a long time, because it’s unnecessary. Almost everything can be done comfortably in our office—without an IV, without sedation. And it requires very minimal down time. Patients wear stockings for a week, but they’re up and around the next day. It’s just not a big production anymore.


Once you remove the veins, will they ever come back?

That depends a little bit on the patient and a little bit on the underlying disorders, and that’s where ultrasound can come in. Spider veins can recur over years. A lot of times they’re related to pregnancy, so if someone has a pregnancy after treatment, veins can come back. Generally, with a few treatments in the office you can get rid of most of those.

Occasionally, a patient will have some recurrent ones over the years and you can do some touchup sessions later. And if there are underlying venous problems we try to address those to minimize the risk of those recurring. But those are different veins that develop; the ones we treat are gone. It’s not like they’re the same veins popping back up again.


Is there anything you can do to prevent varicose veins or spider veins?

It generally is related to a genetic predisposition, and women tend to get them more than men. But there are a few things you can do. Wearing support hose during pregnancy can be helpful. If you have that type of genetic predisposition and you’re in the type of work where you’re standing all day, especially in one area and not moving around much, it can predispose you to them. For some people, there’s not much they can do. But if they come in, we can treat them. You have to be patient. Some things are fairly instantaneous, like large veins, but with tiny spider veins it’s a process. It can take a couple of treatments.


How does your practice differ from others?

Some practices don’t cover the gamut of things like we do, or don’t have a full surgery suite in their office, as we do. Most of the procedures we can do in the office. We have a well-equipped facility, and it’s remarkable how much we can do safely as outpatient procedures. That makes patients happy.

There are a lot of physicians who can do various procedures, but you really have to have a facility that has a number of different devices, so that all of the options are available to tailor to an individual patient. For example, we have a device called a Veinwave, which is a radiofrequency device that helps remove very small veins, like the tiny veins around the nose and cheeks. We do that a lot, and it works extremely well.  And we have lots of other devices and modalities—sclerotherapy, endovascular treatment, endovenous ablation, lasers, various things.


Vascular Surgery Medical Group, Robert Gingery, M.D., Lamont Paxton, M.D., Michael Ingegno, M.D., Varinder Phangureh, M.D.

Alameda, 510-521-4412

San Leandro, 510-357-4006

San Ramon, 925-831-0101


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