Thread veins – Treatment

Treatment of thread veins:

First identify and treat any underlying varicose veins or “hidden varicose veins”

Severe thread veins and varicose veins affecting ankle skin

The most important treatment for thread veins of the leg is the treatment of the underlying cause.
As mentioned previously, almost 9 out of 10 people with leg thread veins have underlying varicose veins or “hidden varicose veins” (incompetent veins) that are causing or contributing to the thread veins. Failure to identify these (with a hand held Doppler as a minimum, but preferably a colour flow duplex ultrasound) results in either bad results from the thread vein treatment or a high chance that the thread veins will return. In a small number of cases, thread veins treated without identifying and treating underlying varicose veins or “hidden varicose veins” (incompetent veins) results in a severe worsening of thread veins – with large matted areas of red thread veins appearing that are very difficult to treat.
If underlying varicose veins or “hidden varicose veins” are identified, these need to be treated first. This maybe by:
No one should ever have to undergo tying and stripping of the veins under general anaesthetic which tends to cause varicose veins to come back again in the majority of cases and can therefore be associated with more thread veins in the future.
Once venous duplex ultrasound has shown that there are no underlying varicose veins or “hidden varicose veins”, or has found these veins and their been successfully treated, then the leg veins themselves can be treated.

Second, choose the right treatments to get the best chance of successful treatment of leg thread veins:

There are a large number of treatments that are offered for leg thread veins, as it is such a common condition. Some of these have no basis in science at all and are virtually useless, others are highly successful in skilled hands.
To understand which are most likely to be successful, it is worth reading the beginning of this website where thread veins are discussed. The thread veins on the surface are real veins with real walls. They are just more dilated than they should be and hence can be seen on the skin surface. They are connected to other veins by deeper extensions which cannot be seen on the surface but still need to be treated if permanent removal is wanted. Thread veins are not “broken veins”. If a vein is “broken”, it means that blood is leaking out of it which is a bruise. Blood does not leak out in “streaks”.
Several companies sell creams to “repair broken veins” containing ingredients such as vitamin K. Firstly there is little or no evidence that vitamin K can be absorbed across the skin, and secondly, even if it was, it would have no effect on the thread veins. The companies selling such creams claim that as the “broken veins” are “broken”, vitamin K helps them to clot and heal. However as we have seen, these veins are not broken and thus even if Vitamin K did get across the skin surface, it would have no effect on these enlarged but real veins.
There are a multitude of other creams available, none of which have been shown to have a lasting effect on thread veins of the legs. They are sold because there are high profits to be made from selling simple solutions and they are usually not medical creams but are sold as cosmetics or “food additives” and therefore do not have to show that they work before being sold. The College of Phlebology invites any company that believes they have a cream that can work to remove leg thread veins permanently to contact us and we will be very happy to arrange a proper study of the product in conjunction with that company.
Laser, intense pulsed light (IPL) and other light therapies:
A great many cosmetic companies that buy lasers, intense pulsed light machines (IPL) or other light therapies for other reasons are also told that they can treat leg thread veins when they buy them to increase the attractiveness of the purchase.
The science behind these treatments is that the light energy from the laser, IPL or other light machine gets absorbed by the haemoglobin in the blood inside the thread vein, heating the thread vein and destroying it.
Although these treatments can be highly successful on thread veins on the face, the thread veins on the legs are totally different. “Thread veins” on the face are above the heart and as such are usually high pressure arterial capillaries that are supplied directly by heart pressure. After all if they were low-pressure veins, they should easily drain away with gravity. In addition, because the skin of the face is always exposed to the sun, the skin is very resistant to light energy. Therefore thread veins on the face are much easier to treat with the light therapies such as laser, IPL and other light treatments, as the vessels tend to be smaller, with lower pressure and the surrounding skin does not easily get burnt and/or damaged by laser or other light energy.
Conversely, thread veins of the legs are below the heart and therefore filled by gravity. The skin of the legs is very sensitive to light energy and burns easily, causing the scars. It is often found that when thread veins of the legs are treated by laser, IPL or other light energy sources, the amount of power needed to destroy the vein often burns and scars the skin. As such, it is uncommon for laser, IPL or other light therapies to get good results for treatment of the leg thread veins. Patients are often left with incomplete treatments with thread veins still remaining, all with discolourations and scars of the skin which may look either dark or conversely may be bright white.
Finally, even if laser, IPL and other light energies did work on the visible veins, they do not treat the deeper extensions of the same veins and therefore do not treat the network of thread veins completely.
Recently a new device claiming to be an “endovenous laser ablation” of thread veins has been popularised in the press. In this technique, a very fine laser fibre is passed into a thread vein which is then treated with laser from within. Such an approach is much more likely to be successful than laser from the outside but it is unlikely that the majority of thread veins can be treated by this technique. Thread veins by their very nature are branching structures and are very narrow. They would have to be relatively large thread veins to be able to put a laser fibre within them. However it will be interesting to see results of studies if they are performed of this technique against microsclerotherapy, which is the current “gold standard” of treatment of leg thread veins.
Needle based electrolysis or radiofrequency destruction of leg thread veins:
There are several different techniques and products around using electricity to generate heat in tissue, and electrolysis or a radiofrequency needle that is placed either on the skin or through the skin next to thread veins. The idea is to destroy the thread vein using this heat, allowing the vein to scar away permanently by fibrosis.
Depending on the skill of the operator, many thread veins of the legs can be treated successfully using this approach. The only concern with these treatments is that they only treat the visible part of the thread veins and not the deeper extensions. In addition, as each vein has to be treated every few millimetres along its length, these approaches are slower than microsclerotherapy.
However provided any underlying varicose veins or “hidden varicose veins” have been checked for and treated first, these treatments can be successful in some patients.

Microsclerotherapy injections (the “gold standard” treatment for leg thread veins):

Microsclerotherapy is the name given to the injection of thread veins with a “sclerosant” liquid which kills the vein wall. The dead vein wall is then removed by the body using a process called “inflammation”. Microsclerotherapy not only treats the visible veins on the surface that are injected directly, but it also spreads into any branching structure killing all of the surrounding branches as well has any deep extension of the thread veins. As such it is the most complete treatment currently available for leg thread veins.
However, as with any successful and powerful medical treatment, there are risks:
  • These sclerotherapy liquid can kill thread veins and therefore if injected outside of the vein and into the skin, can kill the skin causing brown stains or even a breakdown of the skin itself.
  • If the wrong strength is used, particularly if the solution is too strong, excess inflammation of the veins can cause brown staining of the skin.
  • Also to get the very best treatment results, it is essential that after the thread veins have been injected, they are compressed for 14 days and nights. Failure to do so, results in blood flowing back into the treated vein, and clotting as the vein wall is dead. Blood clots in thread vein of the leg start breaking down first going green and then leaving a permanent brown stain. Therefore the best results of microsclerotherapy are found when graduated pressure stockings worn for 14 days and nights after the treatment has been performed.
Because the treated veins have to be removed by a process of inflammation, it is three months before the improvement is seen and it can be up to a year before the full results of microsclerotherapy can be appreciated.
Despite these concerns, provided the microsclerotherapy is performed by an expert using the correct strength and type of sclerosant, and the patient wears proper fitting graduated pressure stockings for 14 days and nights, the results from microsclerotherapy can be excellent and often results in blemish free legs with a very high degree of patient satisfaction.

What to do if you have leg thread veins:

If you identify that you have leg thread veins, you need to see a venous expert who is experienced at assessing thread veins with a minimum of hand held Doppler and preferably colour flow duplex ultrasound. They will then check you for underlying varicose veins and “hidden varicose veins” (venous incompetence) and, if you’re one of the 89% of people who do have an underlying cause for your thread veins, they will recommend the appropriate treatment for your underlying veins first.
Once these have been treated, or if you are one of the 11% of people who do not have an underlying cause, then they will offer you treatment.
You will be able to find a venous expert who treats thread veins on The College of Phlebology. Those members who are MCPhleb assess and treat thread veins and those who are FCPhleb treat both thread veins and the underlying causes of thread veins.
This website was last updated on 03/10/17.