[if gte mso 9]>Endovenous laser ablation (EVLA), also called endovenous laser therapy (EVLT), is my preferred method of treating incompetent perforator veins.  I believe it is more reliable than radiofrequency ablation or sclerotherapy.  Incompetent perforator veins, as well as refluxing great saphenous veins, can feed veins on the surface of the skin, such as spider veins.  It is a standard recommendation in phlebology to treat the deeper refluxing veins before treating the spider veins.  The one exception would be for patients that have no symptoms, no bulging veins or skin changes, and just want some spider veins treated.  In that situation I will offer sclerotherapy or surface laser therapy without necessarily treating the deeper veins.

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