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Sclerotherapy What are Spider Veins?
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 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 causes 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
In the case of varicose veins (big bulging rope like veins visible on the skin), they 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. Your physician as part of your initial consultation will evaluate you for this condition, it may be necessary to have an ultrasound exam to further evaluate the 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. Let us review your informed consent... Potential Risks and Side Effects
Alternative Treatments By signing an informed consent you are acknowledging you understand the risks of Sclerotherapy and alternative methods of treatment. Do not hesitate to ask your physician to explain in more detail any concerns you may have about risk and complications.
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. If the discomfort is too much and you need a break, speak up.
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. What can I expect after the treatment…
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 sore 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
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. 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. Below is an example of a patient with significant hyperpigmentation and the results after flushing out the trapped blood. The pigmentation changes will continue to fade more with time
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. Your Doctor has 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. If you do not think your treatments are progressing well please inform our staff and we will review your treatment plan and progress. 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.
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In most cases they are of a cosmetic concern only, but in some cases they may in fact be related to an underlying medical problem known as venous insufficiency or reflux. In either situation spider veins may be causing you a dull aching feeling. We will explain what differentiates veins as a cosmetic concern versus a medical problem.
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.
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.
