North Shore Vein Treatment Guide

A Patient's Guide To Vein Treatment

We present this comprehensive guide for spider vein and varicose vein treatment in Long Island. While most patients trust the judgement of their vein doctors, an informed patient is prepared with questions. Our vein experts will utilize all the information about your condition and treatment goals before deciding what is best for you.

To begin, we are no longer recommending surgical removal of veins for the majority of patients.  This includes surgical stripping, surgical ligation and endoscopic approaches.  Today, our specialized vein doctors can treat spider veins and varicose veins using minimally invasive procedures that are primarily accomplished in the office without incisions or anesthesia.  This results in incredibly fast recovery and few restrictions around treatment.  Our comprehensive guide will provide a detailed review of recommend vein treatments, including a comparison chart to help you choose the right vein treatment in  Long Island.

Your Vein Treatment Options

Vein Ablation in North Shore 

Also referred to as ablation or RF ablation

Treats the underlying cause of symptoms and visible varicose veins. 

What is endovenous ablation?

RF ablation is our preferred treatment for venous insufficiency.  The minimally invasive  procedure has eliminated the need for more complicated procedures such as surgical stripping.  Besides being more effective than surgical techniques, RF ablation is incredibly safe in expert hands.  The short procedure is accomplished with a catheter inserted through an intravenous line and uses thermal energy to close unhealthy saphenous veins.  

In comparison to laser vein ablation,  radiofrequency has been shown to cause less procedural discomfort.  This may relate to the intensity of energy associated with laser treatment.  Both are equally effective.  Ablation is performed as an in-office procedure with local anesthesia.  As a result, there is now down time and usual activities can be resumed immediately.

How is endovenous ablation performed?

While performing a leg vein ablation, your  doctor will uses ultrasound to identify the target vein and direct the catheter safely.  With simple local anesthetic, the heat source is not felt during vein treatment.  Immediately after treatment, the target vein is closed and circulation is improved.  Patients are able to leave the office with simple compression stockings until follow up.


We are incredibly encouraged by the results of our vein treatment using RF vein ablation.  Safe and effective treatment depends on the appropriate identification of unhealthy veins and expert catheter based skills.  Your vein specialist should have a background in vascular medicine.  Board-certification demonstrates a commitment to maintaining the highest standard of excellence. 

  • Safe and Effective in the RIGHT HANDS
  • No incisions
  • No downtime
  • Excellent Insurance coverage

Experience with ultrasound technique and fine movements using catheters is required.

The risk of DVT is increased with inexperienced practitioners.  In our vein clinic, multiple safety checks and physician guided ultrasound enhances the quality of our vein treatments. 

  • Far too many inexperienced practitioners
  • The non-surgical approach has encouraged the use of this procedure among novices including pain management doctors, physiatrists, and non-vascular physicians
  • Must be performed by board-certified vein experts
Am I a good candidate for endovenous ablation?

For most patients without prior vein treatment, endovenous ablation is the first choice for managing venous insufficiency.  Contraindications include active thrombophlebitis, deep vein thrombosis (DVT), pregnancy, and certain  individuals with implantable cardiac devices.  


Also reffered to as The Vein  Glue

Treats the underlying cause of varicose veins and symptoms.

What is Venaseal?

VenaSeal is an exciting technology that has FDA approval to treat chronic venous insufficiency. Venaseal uses a medical adhesive called cyanoacrylate to seal the diseased vein’s walls.  

How is Venaseal performed?

There are a lot of similarities with other endovenous treatments.  Venaseal is also performed under ultrasound guidance with a catheter-based technique.  With Venaseal, the main difference is the catheter is used to deliver the medical glue in place of heat energy to close the unhealthy veins.  


Because VenaSeal does not utilize thermal energy, it can be performed with very minimal local anesthetic.  Additionally, there is no risk of heat injury to the skin.  In comparison to RF vein ablation, patients favor Venaseal also because there is no need for post treatment compression stockings.

  • Eliminates risks of nerve or skin injury 
  • Removes need for Post operative compression
  • Less local anesthetic requirement for procedures

VenaSeal has limited insurance coverage at this time due to its new entry. Additionally, long term data is lacking.

There are incident reports concerning for intolerance or allergic reactions to the adhesive.  These reactions cannot be reliably predicted ahead of time and can have serious consequences. 

Venaseal has a very high learning curve and even experienced vascular doctors are not comfortable with its use.  Only Venaseal trained physicians should be considered. 

  • High learning curve for safe and effective treatment
  • Early reports of allergic reactions that needs further data to determine extent
  • Limited Insurance Coverage in Long Island
Am I a good candidate for Venaseal?

Venaseal is appropriate for patients with underlying venous insuffiency appropriate for endovenous technique.   Selection must also consider insurance coverage ahead of time. 


Also known as  Vein Injections 

Treats spider veins and superficial varicose veins

What is sclerotherapy?

Sclerotherapy refers to the injection of a sclerosant into small surface veins. The medication irritates the  target spider veins, making them to spasm and shrink.  Over time, the spider veins fade away from your skin. 

Sclerotherapy has been the standard for spider vein treatment for many decades.  Hypertonic saline was the most common sclerosant, however most  high-end vein clinics now use polidocanol or STS as the preferred agent.  These medications are equally effective and have significant advantages over hypertonic saline.  

How is sclerotherapy performed?

Sclerotherapy is preferred for cosmetic treatment of spider veins.  It has success with both small to large clusters of spider veins.  With enhanced techniques including polarized vein lights and augmented visualization, even difficult to treat spider veins can be effectively removed these days.

During a typical session, the vein doctor will inject sclerosant directly into spider veins and feeder veins. The procedure takes about  15 to 30 minutes, following which you can resume your daily activities.  The best time of year for cosmetic treatment tends to be during Fall and Winter months to allow adequate time for the veins to fade.


Sclerotherapy is far more effective than laser for most spider veins.  Laser is typically best for facial veins and tiny capillaries on the feet. 

  • Safe with Polidocanol and STS
  • Effective
  • No downtime
  • Enhanced techniques allow for treatment of all types of veins using sclerotherapy.

Effective sclerotherapy depends on many factors including knowledge of proper dilutions, the right medication and technique.  This requires a high level of experience to avoid issues like hemosiderin staining, phlebitis and ulcerations.  

  • Inexperience is associated with poor patient satisfaction
  • Not appropriate for facial veins or small capillaries on the feet.
Am I a good candidate for sclerotherapy?

Sclerotherapy is the preferred treatment for spider veins.  A vein expert can provide you with honest expectation of results with treatment.

Foam Sclerotherapy

Also known as Ultrasound guided sclerotherapy

Treats reticular and  varicose veins

What is foam sclerotherapy?

Foam sclerotherapy is a more effective technique with sclerotherapy.  Unlike traditional sclerotherapy, the sclerosant is either pre-mixed or physician compounded with air prior to injection.  As a result, the medication has a foam consistency and is able to keep better contact with targeted vessels for successful treatment.  

How is foam sclerotherapy performed?

Foam sclerotherapy is injected under ultrasound guidance by a trained vein specialist.  Safety and efficacy is improved with multiple, small volume injections along the length of the abnormal vein. 


Foam sclerotherapy is an enhanced technique for large visible veins unsuitable for venous ablation.

  • Improved contact with the walls of targeted vessels than liquid sclerotherapy
  • Suitable for segments at the very surface of skin or near nerves

Foam sclerotherapy can damage healthy veins when injected by inexperienced physicians.  A trained vein specialist has a detailed understanding of the leg vein anatomy to provide safe treatment.


  • Best performed only be vascular doctors
  • Risk of DVT increased with inexperienced injectors
  • Phlebitis after treatment
Am I a good candidate for foam sclerotherapy?

Foam sclerotherapy is often used in combination with ablation to provide more complete results.  The key is to have a complete understanding of the anatomy.


Also known as Sonovein

Treats venous insufficiency

What is Echotherapy?

SONOVEIN® is currently available in select European countries after receiving CE-mark approval.   It was recently approved by the FDA for clinical trials in the United States. These studies are ongoing and will provide the necessary safety and efficacy data before approval in the US.  SONOVEIN® represents the first robotic solution for a 100% non-invasive treatment of varicose veins. Unlike current endovenous procedures, the treatment is performed completely outside the body.  There are no catheters, incisions or post procedure scars.  SONOVEIN® is directly operated by the vein specialist without any significant preparation.  Patients can resume their normal daily activities immediately after treatment.


Vein ablation by echotherapy and radiofrequency have identical tasks – the elimination of source (feeder) veins into symptomatic varicose veins.  The main benefit of echotherapy over current therapies available in the US is being completely non-invasive.

The high-intensity ultrasound beam (HIFU) is focused on the vein.  A pulse of therapeutic ultrasound is then delivered for a few seconds at the target segments of the diseased vein. As the thermal energy is delivered, the vein shrinks and is sealed closed, similar to other endothermal methods – but non-invasively.  Pulses are provided until the complete target area is treated.


Am I a suitable candidate for Echotherapy?

Echotherapy is under trial investigation in the United States.  It is not available for routine use until safety and efficacy are reviewed by the FDA.

North Shore Vein Clinic For An Unparalleled Experience

Our spider and varicose vein treatment centers in North Shore LI is led by board-certified vein doctor specialist, Dr Simon Smith.  He specializes in the latest minimally invasive vein treatments providing an unparalleled experience to our vein center.  If you have any other questions about the vein treatments or feel one is right for you, please reach out to our vein team for an evaluation.

Experienced Vein Doctors

At the top of your treatment team is a vein specialist whose experience and attentiveness to your concerns is paramount to the best experience.  Our vein doctors are part of your entire journey.  In fact, we make a point to keep all our vein clinics physician-led from the initial consultation to ongoing treatments and follow-up appointments.   At no point is your care put in the hands of anyone besides your vein doctor.  

smith before and after review
LI Vein Team

A Friendly Team

One thing we cannot overemphasize in our NJ Vein Treatment Guide is the importance of building a lasting trust with your vein team.  Successful spider vein and varicose vein treatment requires dedication and patience.  Each visit is an opportunity to enhance the feeling and appearance of your legs.  We invite each patient to keep direct contact with their vein specialist.  We appreciate patients keeping us honest!

Physician-Led Teams

A vein specialist is comfortable with all aspects of the diagnosis and treatment of vein disease.  Most importantly, they are part of your journey from beginning to end.  We do not utilize nurse practitioners or physician assistants at our vein clinics. 

Vein Doctor Clifton NJ
spider vein treatment

Customized Treatments

  • Modern, state-of-the-art facilities
  • Non-surgical
  • Invested into cutting-edge therapies
  • Individualized to your needs
  • Enhanced tools for spider vein treatment

A consultation with experienced vein specialists will provide insights to help you decide on the best vein treatment plan.

It’s important to have a treatment plan tailored to your specific condition. Varicose veins and spider veins do not fit just one pattern.  Conservative measures such as compression stockings and exercise continue to be important tools in treatment. For individuals with persistent symptoms or more advanced disease, minimally-invasive treatments are available and preferred.

Still Unsure About Vein Treatment?

Vein treatment does not have to be scary or confusing.  Many of our patients come for simple consultations to put them at ease. If varicose vein treatment is indicated, our doctors will customize a treatment plan based on your condition and goals. 

Questions? Call us right away (516) 464-1699

    Still Unsure About Vein Treatment?

    Vein treatment does not have to be scary or confusing.  Many of our patients come for simple consultations to put them at ease. If varicose vein treatment is indicated, our doctors will customize a treatment plan based on your condition and goals. 

    Questions? Call us right away (973) 200-7330​

      Treat With Your Legs With Confidence!

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