Spider Vein Treatment

The first step in treating spider veins is to determine if there is any larger source of vein failure and reflux pushing into and causing the spider veins. This determination is best accomplished through comprehensive evaluation by an expert. If indicated, a detailed vascular assessment utilizing duplex ultrasonography must be performed. Once larger vein insufficiency has been ruled out or treated, focused treatment of the spider veins can begin.

Sclerotherapy is the treatment of choice for most spider veins, particularly those in the legs. Loupe magnification, targeted lighting, and micro needles are used, along with an FDA approved sclerosing solution to treat and “close down” the spider veins. Once closed, these veins will dissolve through the body’s natural processes. For best results patients will be asked to wear prescription grade support stockings for a brief period of time following their sclerotherapy treatment. Patients typically undergo two to six treatments to obtain the desired results. The average number of treatments is three to four for most patients. Once the veins are treated and dissolve, those veins will not return. However, new spider veins can form over time and they tend to appear in the areas where one has been prone to developing them.

Surface lasers like the 532nm KTP laser and the 1064nm Nd: YAG laser are sometimes useful for these veins, however, due to the associated heat, pain and slower treatment times with these lasers, most experienced experts rely primarily on sclerotherapy for the best results when treating spider veins.


The principle of sclerotherapy is to irritate the unhealthy veins with a solution that will cause them to permanently close. Once this has occurred, your body’s natural processes gently dissolve the treated veins ridding the area of the spider-like veins and the unsightly appearance. We are able to perform this procedure with minimal discomfort with the aid of magnification, special lighting and needles smaller than those used for acupuncture.

Classically, a solution known as hypertonic saline was used for sclerotherapy of spider veins. This solution has largely been abandoned as newer, more effective options become available. These solutions have since received FDA approval specifically for the treatment of spider and varicose veins due to their efficacy and safety. They work better than the older saline approach because there is much less discomfort, more veins can be treated in one visit, and concerns related to pigment deposition (staining) after treatment are significantly decreased.

Currently, our sclerosant solution of choice is a brand known as AscaleraTM (polidocanol). This FDA approved medicine has been shown to have the lowest incidence of pigment deposition following vein treatment and patients have the least discomfort when treated with this solution. Some vein practices prefer to have large batches of this solution made at local compounding pharmacies in order to save money by buying large single containers and then dividing the dose between patients as they arrive for treatment. We never use local pharmacy compounded versions of these medicines. Each patient receives his or her own unique single dose from the FDA approved pharmacy factory source. This ensures the integrity and sterility of the solution for each patient.

Ultasound-Guided Sclerotherapy

For more complex varicose veins located slightly further below the skin, and therefore out of sight, we are able to precisely identify and target these damaged veins by using the latest ultrasound technology to accurately see, target and effectively treat these veins completely.

Foam Sclerotherapy

More than 10 years ago, a technique known as foam sclerotherapy was developed in Europe. Its benefits became quickly apparent to the medical community and it has been widely accepted as the current, most effective way to treat varicose and spider veins when sclerotherapy is used. Foam sclerotherapy is performed by adding air micro-bubbles to the liquid sclerotherapy solution. This creates a slurry or foam that more effectively fills the targeted vein. With the foam solution there is significantly greater contact between the vein’s inner wall and the solution. This not only results in a much more successful vein closure rate but also greatly increases the number of veins that can be treated in a single treatment session.

EVLT or Endovenous Laser Therapy

Endovenous Laser Therapy (EVLT) is the use of targeted laser energy to safely and gently eliminate the veins causing varicose veins. At the Austin Vein Institute, it is performed using our advanced 1420nm water-focused diode laser. The 1420nm laser is one of the newest lasers offering a focused light wavelength targeting intracellular water of the vein wall. This targeted approach allows the reliable and accurate treatment of large varicose veins, while avoiding much of the pain and bruising typically associated with stripping and older laser therapies.

We perform this procedure in our office under sterile conditions. Because of the relatively short treatment time and minimal discomfort, sedation and its attendant risks are avoided. We use a localized injection of lidocaine to numb the area, thus, avoiding pain during the treatment. This procedure can be performed in about 30-40 minutes. Patients are able to get up and walk immediately following the procedure. All normal activities can be resumed following any of our procedures. Patients can return to work the same day or the following day, as they wish. Patients are encouraged to remain active and no downtime is expected. Some mild to moderate tenderness is occasionally noted. This is similar to that following a workout at the gym. This is typically resolved with regular activity and by walking and remaining limber.

Surface Laser

Surface lasers for the skin, like our 532nm KTP lasers and our 1064nm Nd: YAG laser, are sometimes useful for very tiny spider veins. The challenge with surface lasers for spider veins in the legs is the very high pressure on these veins. As a result, surface lasers for spider veins in the legs are often not very effective. Another issue that arises with these surface lasers when treating spider veins in the legs is the heat, pain, and slower treatment times when compared with modern sclerotherapy for spider veins. Most experienced vein experts rely primarily on sclerotherapy for best results when treating spider veins on their patient’s legs.

Prescription Compression Stockings

Prescription compression stockings (or socks) are designed to create circumferential external pressure on the leg, to counteract the abnormally high outward pressure of varicose veins on the surrounding tissues and skin. While compression stockings do not prevent or cure spider or varicose veins, they can help relieve some of the symptoms associated with varicose veins such as leg heaviness, pain, and swelling.

Before most insurance plans consider coverage for treatment of your varicose veins, you will be required to try wearing a compression hose to see if it alleviates the problem. If your condition and symptoms persist, then treatment may be covered depending on your policy’s guidelines.

It is always a good idea to try your prescription stockings before treatment so you will be familiar with how they feel and fit. Best results for most vein procedures are achieved when the stockings are worn daily for 5-10 days following your treatment.

Micro Stab Phlebectomy

While endovenous lasers successfully treat weak varicose veins, this is not always the best option when trying to eliminate all bulging surface veins. In some instances, micro stab phlebectomy is used to quickly remove these bulging veins, typically in one simple treatment.

Micro-stab phlebectomy is a minimally invasive procedure to treat varicose veins done in the comfort of our office. After an anesthetic solution is injected into the area, a series of small 2-3mm incisions are made where a fine instrument is inserted through the small opening to remove the vein(s).

An ace bandage and compression stocking are all that’s needed after the procedure. This procedure typically takes around 30 to 45 minutes to perform and is almost always performed in an outpatient setting, allowing the patient to return home the same day as the procedure. Patients are usually able to see results shortly after the procedure, and due to the small size of the incision, there is virtually no scarring left behind.

Venous Reflux Exams

Here you will find compassion and understanding as Dr. Brennig, the vascular expert, listens to your concerns to gain insight into any vascular problems you might be experiencing. You will then go through a comprehensive vascular evaluation. This includes an in-depth vein ultrasound study that is used to locate the root cause of potential vein problems. Dr. Brennig will then review the findings and explain the best treatment plan for you. Our state-of-the-art, minimally invasive procedures allow for quick recovery and no significant down time. Dr. Brennig personally performs all treatments at the Institute.


Varicose veins are under abnormal pressure and often bulge pushing up the overlying skin. This is not only unsightly, but also painful. While endovenous lasers successfully treat the weak veins pushing backward into these clusters, it is not always the best way to eliminate all bulging surface veins. In some instances micro phlebectomy is used to quickly remove these bulging veins, typically in one simple treatment.

Like all of our treatments, micro phlebectomy is performed in the office setting. A small area around the vein is numbed and a tiny incision (with a small needle) is made through which the bulging vein is removed. These micro incisions are so small, no sutures are ever necessary. The area is simply covered with sterile gauze for 24 hours. Patients are encouraged to resume regular activities right away.