Why did my spider vein treatment not work?

Help! My spider veins came back after they were treated!

You decided to work up the nerve to do something about the spider veins on your legs. You went to get treatment, and you have a solution injected into your spider veins. In the office you see them seemingly disappear before your eyes. “This is great! Finally, they are going to go away!” you say to yourself. Maybe they asked you to wear compression hose for a couple weeks, maybe not. But one day you find yourself looking at your legs and realize with horror the veins came right back! What happened?

First, do not be discouraged. In the majority of cases spider veins can be successfully treated with visual sclerotherapy (injections). But unfortunately, there are several factors involved that can influence your vein treatments. Below are some of the reasons your spider vein treatment may not have been successful.

Your Underlying Veins Are Dysfunctional

Probably the number one reason my patients have not had success with sclerotherapy is because they have underlying varicose vein disease that they didn’t realize was there. These underlying veins, if dysfunctional, are going to hinder any type of treatment regardless of the strength of the medication or the skill of the injector. That’s because these varicose veins are essentially pushing blood back into your spider veins. Injecting the surface veins without treating the underlying varicose veins is like putting on a band-aid when you have internal bleeding. It won’t fix it. Before we begin to treat your spider veins, we will scan your legs with an ultrasound to make sure you do not have an underlying issue.

The Medication Was Not Strong Enough

There are several medications out there on the market that are used for spider veins. Only two are FDA approved for treatment of veins: sodium tetradecyl sulfate and polidocanol. These are the medications we routinely use in our office due to their superior efficacy. They coat the lining of the blood vessel and cause it to shrink or stick together. Hypertonic saline is often routinely used in non-vein center offices. However, it works slightly differently. It actually causes hemolysis, or destruction, of your red blood cells. It also destroys the lining of your blood vessels. But it is typically only used on the small spider veins, not on those bulging blue and green veins. Those veins often are “feeding” the spider veins. It is essential to close those “feeder” veins down first before you start injecting the spider veins in order to get the best results.

The Skill of the Injector

Injecting veins may seem easy, but there is definitely a lot of skill involved. You need a skilled injector, someone who has been doing this for a while. A lot of people dabble in vein treatments, but we specialize in it. It is what we do multiple times a day, every day.


When done correctly spider veins can be successfully treated in the majority of patients. Just remember that there are a lot of different factors involved: your underlying veins, the medication, and the skill of the person injecting are just a few. Don’t let a failed attempt keep you from pursuing the legs that you want!

Written by: Chelsea Campbell, FNP-BC

Tagged with: ,

Posted in: Spider Veins, Varicose Veins


  1. Nice work.

    Comment by David on August 7, 2017 at 12:10 am

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