Sclerotherapy

Spider Veins

Spider veins can be a problem for many people. You are not alone in your desire to rid yourself of these unsightly veins. You may have had them for years or they may have just recently become a problem for you.

Spider veins - known in the medical world as telangiectasias or sunburst varicosities - are small, thin veins that lie close to the surface of the skin. Although these super-fine veins are connected with the larger venous system, they are not an essential part of it.

A number of factors contribute to the development of spider veins, including heredity, pregnancy and other events that cause hormonal shifts, weight gain, occupations or activities that require prolonged sitting or standing, and the use of certain medications.

Spider veins usually take on one of three basic patterns. They may appear in a true spider shape with a group of veins radiating outward from a dark central point; they may be arborizing and will resemble tiny branch-like shapes; or they may be simple linear and appear as thin separate lines. Linear spider veins are commonly seen on the inner knee, whereas the arborizing pattern often appears on the outer thigh in a sunburst or cartwheel distribution.

The Circulatory System

Arteries carry oxygenated blood to your legs and the veins carry de-oxygenated blood away from your legs. The blood returns to the lungs to pick up more oxygen and returns to the heart to be pumped out again through the arteries.

The venous system has two components. The first is the deep venous system. It lies below the muscles and transports 90% of the blood away from your legs. It is the system that can get blood clots, which may be life threatening if not treated. It usually has nothing to do with your spider veins.

The second component is the superficial venous system. It transports approximately 10% of blood away from your legs. You can get clots in this system that cause pain and discomfort (superficial phlebitis) but they are not life threatening. The superficial system is the system that involves varicose and spider veins.

Veins have one-way valves that open up as the blood travels upward, and then close down tightly to prevent the blood from leaking back down. The deep and superficial veins both have these valves.

When the deep system has faulty valves (the valves do not close tightly allowing the blood to leak back down) you will develop profound and chronic swelling. When the superficial system has faulty valves you may develop varicose and spider veins.

Understanding Reflux

The condition that results from these leaky valves is known as reflux. When the blood is refluxing back down the legs it puts excess pressure on the vein walls which causes them to expand. This expansion causes the valves to be even more ineffective.

In the picture to the left, the black markings represent the deep venous system. The red marking represents the superficial system. The Saphenous Vein is the main tree of the superficial system. Varicose and spider veins are like the branches of the tree.

Varicose veins (big bulging rope like veins visible on the skin) are almost always related to leaking valves in the Saphenous Vein (the main tree of the superficial system). In rare cases you may have reflux in the saphenous vein that can contribute spider veins without having varicose veins.

As part of your initial consultation we will evaluate you for this condition, it may be necessary to have an ultrasound exam to further evaluate the veins in order to correctly treat your condition.

Should an ultrasound confirm reflux in the saphenous system, your spider veins will not respond to treatment without first treating the underlying reflux. In these cases your insurance company may consider the treatment of the saphenous vein as medically necessary. After the reflux is treated the spider veins will respond better to sclerotherapy. However, once the reflux is treated there is no longer a medical problem and insurance companies consider the remaining spider veins a cosmetic problem.

Your physician will develop a treatment plan for your individual case. Spider veins can be successfully treated with injection sclerotherapy.

Sclerotherapy is a very popular method of eliminating spider veins. A solution called a sclerosing agent is injected into the veins. This solution causes an irritation to the inner lining of the vein resulting in closure of the vein. The majority of persons who have Sclerotherapy performed have satisfying results.

The number of treatments needed differs from patient to patient, depending on the extent of the problem. An average of three to four treatments is required in most cases to achieve a 70%-80% clearing; 100% is not a realistic goal. The treatment sessions are done at four to six week intervals to achieve optimal results.

After the initial series of recommended treatments are completed successfully treated veins are gone, but patients with a history of spider veins tend to develop new ones and a yearly touch up is recommended.

Sclerotherapy is a treatment for spider veins  - not a cure

Sclerotherapy is a very safe and effective treatment for spider veins, however all medical procedures carry potential risk and side effects.

Potential Risks and Side Effects

• Transient hyperpigmentation: After sclerotherapy you may notice some discoloration (dark streaks) after treatment. This occurs when the blood gets trapped inside the vein after it closes down. We can usually “flush” the trapped blood out on your next visit. If the flushing does not alleviate the discoloration it will fade on it’s own in 4 to 12 months. In rare instances this darkening of the skin may persist for years.

• Skin Ulceration: In rare cases, a blister may form, open, and become ulcerated. Healing occurs slowly over a few months. After healing, this may leave a scar.

• Allergic Reaction: Very rarely, a patient may have an allergic reaction to the sclerosing agent. The risk of this is greater in patients who have a history of allergies.

• Deep Vein Thrombosis is a very rare complication. The dangers of deep vein thrombosis include the possibility of pulmonary embolus (a blood clot carried to the lungs) and post phlebitic syndrome, resulting in a permanent swelling of the leg.

• Most Common Side Effects The veins may be tender to the touch after treatment, and an uncomfortable sensation may run along the vein route. This discomfort is usually temporary. Bruising is very common and to be expected. Some patients complain of an itchy sensation after treatment, which is also very normal. Trapped blood may cause a discoloration, this may leave hyperpigmentation up to one year.

Treatment Expectations

Before beginning the treatment your legs will be cleaned off front and back with alcohol. This is a cold sensation but not uncomfortable. Infection is highly unlikely with sclerotherapy, but this type of preparation is standard before any type of injection.

A very small gauge needle is used to perform the injections. Most patients relate the discomfort to that of an ant bite.

Often you will see the spider veins on the surface of your legs but may be unaware of a network of veins not so visible which may be feeding the spider veins.

We will first look at your legs with an illuminating light which helps us to identify any feeder veins. In some cases the feeder veins may be extensive and in other cases minimal. This will be part of what your physician bases the estimated number of treatments you may need.

If you have extensive feeders your first treatments will concentrate on these veins. Since you could not see them you may not notice a dramatic change in the appearance of your legs initial. In most cases you will see the most impressive changes after the second and third treatment.

Your treatment session will take approximately 30 minutes. We are limited to the amount of medication we can inject because of maximum dosage limits specific to the medication we use.

We try to treat as many veins as possible during your session. If there are specific veins that bother you more than others, please make us aware of those veins so we can start with those first.

After your treatment the veins we be red and irritated as shown above. There may be welts at the site of injection which are a normal histamine reaction. The areas treated may be itchy for an hour or two after the treatment.

Post Treatment Expectations

After your treatment you will need to put on your compression hose. We ask that you wear the hose during the day for one week following your treatment, removing them to sleep.

Your legs may be uncomfortable for several days. We encourage walking for twenty minutes twice a day to promote healing. If you are involved in an exercise program you may continue as tolerated.

You may notice a significant amount of bruising, this is normal and to be expected. The bruising will fade in approximately ten days to two weeks.

Please avoid any hot tub baths for ten days as this will decrease the effectiveness of the treatment.

Hyperpigmentation

Significant Hyperpigmentation	Mild Hyperpigmentation

After your treatment you may notice that you have dark lines where your veins were. This is where the veins have closed down and there is no longer any flow through the vessel. Blood has gotten trapped inside the vein and it appears dark. This is actually a good sign that the treatment was effective. The degree of pigment changes varies greatly based on the extent and type of spider veins you have.

If you have very prominent raised spider veins the trapping of blood may be more significant as demonstrated in the picture on the left. In these cases, during your next treatment session we can “flush” the area out with an anesthetic solution. This helps to break up the trapped blood so the body can absorb it more easily.

The picture on the right demonstrates mild hyperpigmentation which can occur with any type of spider veins. This degree of hyperpigmentation requires no treatment and will fade gradually.

Ninety percent of all hyperpigmentation left untreated will fade with time, sometimes taking up to one year. It is rare that pigmentation changes are permanent.                                                          

Realistic Expectation of Results

It is important to remember that it has often taken years for these veins to develop, and they will not disappear overnight. We will give you an estimate of how many treatments you will need. It is important to keep a regular schedule of treatments every four to six weeks for the prescribed number of treatments.

It is reasonable to expect a 70%-80% clearing of your spider veins, however some people will just not respond well to the treatments and we have no way of knowing how you will respond. It is not realistic to expect 100% clearing.

Remember, once your have achieved the expected results, new veins will develop over time. We recommend a touch up session every six to twelve months as needed.

Below are photos of typical sclerotherapy results.

We look forward to helping you improve the appearance of your legs.

  
Before Treatment                  After Four Treatments

Before Treatment	After Treatment