Drs. Michael Malinowski and Eric J. Hohenwalter

Michael Malinowski, MD, vascular surgeon, and Eric J. Hohenwalter, MD, FSIR, interventional radiologist, answer common questions about treating spider veins and varicose veins.
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We specialize in the treatment of varicose veins and spider veins using a multidisciplinary approach, with a team of board-certified providers. Our goal is to help you understand your venous condition and offer the highest quality care to alleviate vein disorders.

We are proud to serve the community as the only academic medical center specializing in the treatment of venous disorders.

Varicose Veins

Varicose veins form when valves in the vein become weak and don’t close properly. Veins can become bulged with pools of blood when they fail to circulate blood properly. These visible and bulging veins are often associated with symptoms such as tired, heavy or aching limbs. In severe cases, varicose veins can rupture, or open sores (ulcers) can form on the skin. Varicose veins are most common in the legs and thighs.

Spider Veins

Spider veins appear on the surface of the skin. They may look like short, fine lines, “starburst” clusters or a web-like maze. Spider veins are most common in the thighs, ankles and feet, and may also appear on the face. They may itch, burn or ache, and can be found alone or in combination with varicose veins. Causes of spider veins include genetics (many women with spider veins have mothers and/or female relatives with spider veins), pregnancy, prolonged standing and sitting, injury and high pressure from varicose veins. Spider veins are often a cosmetic vs. a health concern.

Get Answers to Frequently Asked Questions

Treating Vein Disorders

Most problem veins — from the tiniest spider veins to the largest varicose veins — can be treated without surgery. Physicians use advanced technology and techniques to safely and efficiently treat vein disorders, with pleasing results for patients.

Treatments include:

  • Sclerotherapy — The procedure, also known as chemical ablation, treats varicose veins by using a tiny needle to inject a solution (liquid or foam) directly into the veins. The solution irritates the lining of the veins, causing them to contract and collapse. Blood in these veins is directed back into deeper, normal veins.
     
  • Microphlebectomy — A technique to remove varicose veins by making tiny incisions in the skin through which the varicose veins are removed. Stitches are usually not required.
     
  • Endovenous ablation — A treatment for varicose veins that uses either radiofrequency (RF) or laser energy to cauterize a faulty vein, allowing the blood to be diverted to other normal veins. Endovenous ablation will not only improve the cosmetic appearance of the legs, but will help to relieve the aching, swelling and inflammation of the legs associated with varicose veins. The use of RF or laser energy is a major advancement over the traditional method of vein stripping, in which incisions are made in the groin area and near the ankle and a wire-like instrument is inserted into the vein to “strip” it from the inside. Ablation techniques are much less invasive, and patients are able to resume normal activities much sooner than with vein stripping.
     
  • VenaSeal™ — This FDA-approved treatment treats varicose veins close to the surface of the skin. Using a catheter inserted through the skin, a small amount of medical glue is injected into the affected vein, sealing it shut. Blood is then redirected to deeper veins. This option does not require heat, and is designed to minimize patient discomfort and reduce recovery time.
     
  • Compression stockings — Compression stockings are recommended for those who have pain in their lower extremities due to swollen, enlarged veins. Compression therapy is often suggested as the first line of conservative treatment. FORME has a variety of stockings available for purchase without needing a prescription.

Depending on a person’s vein problem, treatment may involve one procedure or a few procedures. In most cases, patients can resume their normal activities the next day — or sooner. 

Patients with spider veins and varicose veins often have other health problems in addition to their vein disorder, such as heart disease, diabetes and kidney disease. Our team of physicians works closely with a variety of specialists and with patients’ physicians to ensure coordinated care. 

Your First Visit

During your first visit, one of our providers will conduct a comprehensive evaluation of your vein system, take your medical history and conduct a physical exam — which may include an ultrasound exam of the veins in your lower extremities. All of these processes combine to help the provider determine the optimal treatment plan for you.

Following the exam process, the provider will discuss your test results and review the treatment options appropriate for your disorder. Your treatment plan will be customized to your needs.

The diagnosis and treatment of significant health problems due to diseased veins are covered by most insurance companies if the problem is deemed "medically necessary." However, some venous conditions are considered cosmetic by some insurances, and may not be covered. We will determine if your vein disorder is causing health problems or if it is strictly cosmetic. It may take some time to work with your insurance to determine coverage.

As your treatment date nears, we will contact you with instructions, remind you to obtain compression stockings and answer any questions you have.

What to Expect for Your Vein Treatment

You will arrive one hour before your procedure. You will be awake during the procedure, but we can offer a mild sedative when you arrive. You will disrobe below your waist down to your underwear and put on a gown. We will prep your leg or legs, and you will lie flat on your back or on your stomach depending on the veins we are treating.

Procedures involve a series of needlesticks, and almost all procedures use a local anesthetic. Once we administer the local anesthetic, you should not feel anything other than occasional pressure. Sclerotherapy does not need local anesthetic, as it is administered with a very fine needle.

You will be able to walk normally after your procedure. All procedures, except schlerotherapy, require that you have a driver to take you home. Your legs will be numb for a few hours until the local anesthetic wears off. After that, you will manage any discomfort with an over-the-counter pain medication or non-steroidal anti-inflammatory medication.

Vein Treatment Follow-Up Care

For one week after treatment, you cannot lift items greater that 20 pounds or travel by plane. You should also not do strenuous exercise for a week. If your job requires any of these activities or that you stand for long periods of time, you should consider taking a few days off or request light duty.

You cannot take a shower for the first three days. You will need to wear thigh-high or waist-high compression stockings for a total of three weeks after your procedure. For the first week, you wear them day and night. For the next two weeks, your wear them only during the day. You will need to purchase the stockings and bring them with you to your procedure. Failure to wear compression stockings as prescribed could lead to the recurrence of spider or varicose veins. If you receive VenaSeal treatment, you will not need to wear compression stockings.

You should also avoid tanning or prolonged sun exposure before and after treatment.

Vein Treatment Risks

There is a very low risk of blood clots after your procedure — less than 1% in normal or low-risk patients. If you are on anticoagulation medication, you can remain on it for the procedure. If you are at risk to develop a blood clot, we may ask you to speak with a hematologist or vascular medicine specialist about taking an anticoagulant to reduce your risk.

We will schedule a follow-up exam within one week of your procedure. You will have an ultrasound to check for blood clots. If we find a blood clot, we will have you take an anticoagulant and follow up with you again in one month with another ultrasound to make sure the blood clot has dissolved.

FORME Aesthetic and Vein Center

All vein services — physician consultations, treatments and follow-up visits — are performed at the FORME Aesthetic and Vein Center. Here, our team of surgeons and vascular and interventional radiologists, combine with advanced practice providers, medical estheticians, aesthetic nurses and board-certified specialists in dermatology, facial plastic surgery and plastic surgery. Together, this multidisciplinary team delivers the latest in aesthetic, nonsurgical and surgical cosmetic and vein care options in a beautifully designed new space. FORME is located in the Tosa Health Center.

Virtual Visits Are Available

Safe and convenient virtual visits by video let you get the care you need via a mobile device, tablet or computer wherever you are. We’ll gather your medical records for you and get our experts’ input so we can offer treatment options without an in-person visit. To schedule a virtual visit, call 414-955-1050.

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