Treatment of Spider or Varicose Veins Using Sclerotherapy
Spider Veins are dilated skin capillaries and are frequently an inherited tendency, although they may be brought on by sun exposure, trauma, aging, prolonged standing, or liver abnormalities.
Varicose Veins are enlarged or swollen blood vessels caused by faulty vein valves which cause a backup or leak of blood in the venous system. They are located somewhat deeper than spider veins, are sometimes raised, and often appear blue. The veins become dilated, engorged and may become inflamed or painful.
Sclerotherapy consists of injecting a solution directly into these vessels and veins, using very tiny needles. This irritates the inner lining of the vessels and they cease to carry blood. Simultaneously, without harming the circulation, the body slowly replaces the inner lining of the vessels with scar tissue. The venous system is very redundant, therefore closing off one vessel will not impact the overall circulation.
Several injections may be required for treatment of the affected areas. Lasers are now available to treat spider veins, however, sclerotherapy is still considered the treatment of choice. The lasers are only effective on very fine vessels which are often too difficult to inject.
A number of solutions are currently used in our practice:
Hypertonic Salt Solution (saline – 23.4% NaCl):
Currently a very popular method. Advantages include more rapid improvement and no potential for allergic reactions. Disadvantages include discomfort, muscle cramping, and potential ulceration or sloughing of surrounding tissue.
Sotradecol and Sodium Morrhate:
These are the only agents approved by the FDA. Approval was granted many years ago. Although they do a very good job at sclerosing veins, they are mild with more painful, and have a greater risk of ulceration, tissue destruction and permanent pigmentation, and have a higher risk of allergic reactions.
Used for the treatment of small spider veins and broken capillaries. Due to the fact that glycerin only irritates the inner lining of vein vessels, there is a significant decrease in bruising, swelling, and post-procedural hyperpigmentation. The use of glycerin also demonstrates a better, more rapid clearance of treated veins.
Potential Side Effects:
- Incomplete Removal of Veins: This is not a side effect, but simply a fact. Some vessels may be completely obliterated with one treatment, and some may take several injections before they are eradicated. Very likely, some vessels will persist, especially the very tiny veins. 75-80% improvement is considered to be a very good result.
- Recurrence: Unfortunately, treatment does not prevent new dilated veins from occurring. The same processes which caused the initial vessels are still at bay and are very likely to cause new vessels as time goes on. Pressure hose/stockings and leg elevation can minimize the recurrence.
- Pigmentation: After a vein is injected, you may see brown spots or bruising at the site where the needle penetrated the vein, as well as a linear brown streak along the path of the vein. Most of this fades over the following six months, but a small amount may be permanent.
- Ulceration: When solution leaks out of the vessel into the surrounding tissue, it irritates the skin as well as the vessel, and may cause ulceration, or sore. The skin heals, but may leave a scar (usually resembling a vaccination scar).
- Clot: Sometimes a tiny clot will form in one of the larger vessels. This may be removed in a few weeks if necessary, and does not carry the risk of internal problems.
- Superficial Thrombophelebitis: This is an irritation of the larger vessels closest to the skin. It is a rare occurrence (approximately 1:1000) and sometimes must be treated with anti-inflammatory agents and bed rest.
- Telangiectatic Mats: These are collections of bold, extremely fine blood vessels, which present as pink areas 3-6 weeks after treatment. There is no known explanation for their occurrence. They often disappear spontaneously in 3-6 months, but they may be permanent. These occur in 5-15% of cases.
- Swelling: Ankle swelling is possible a day or two after the procedure, and is more common in patients who have jobs in which they stand for long periods of time.
- Do not take aspirin or products containing aspirin for one week prior to the procedure.
- Do not shave your legs or use moisturizers for 24 hours before the procedure.
- Bring shorts to wear during the procedure. Band-Aids will be used at certain sites, so you may want to wear a long dress or baggy pants after the procedure.
- There are no restrictions on activity following the procedure. Walking is encouraged.
Your legs may look worse for the first week and then will slowly improve. Sclerotherapy generally requires multiple treatment sessions. One to three injection sessions are usually required to effectively treat any vein, and 10-40 veins may be treated in one session. We recommend 4-6 weeks between treatments. The treated blood vessels generally disappear over a period of six months. Although sclerotherapy works for existing spider veins, it does not prevent new ones from developing.