Sclerotherapy

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Sclerotherapy

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SPIDER AND VARICOSE VEINS

At Aesthetic Medicine Associates we have a special interest and expertise in treating your varicose veins and spider veins.  This information sheet hopes to answer some of the questions that you might have about varicose and spider veins.  We would be very happy to answer any other questions that you might have. 

What are spider and varicose veins?

Normally blood travels through healthy veins up to the heart.  Spider and varicose veins, however, are abnormally dilated veins that cannot perform their function.

Spider veins are the tiny red or blue vessels that can appear anywhere on the body but more commonly on the legs, face, chest or even abdomen.  They may be visible as short, seemingly unconnected lines each about the size of a large hair or they may resemble a spider web or tree with branches.  In medical terms spider veins are called "telangiectasias".  They usually occur in association with larger dilated blood vessels (often blue/green in color) called "reticular veins". 

Varicose veins are larger veins that bulge above the skin surface.  Varicose veins are often found in association with larger and deeper vein problems.  If there is a deeper vein problem this will be apparent on your initial examination. 

Dilated blood vessels often cause aching especially with prolonged standing.  Although dilated blood vessels do carry blood they are not very efficient and are often not necessary to the circulatory system.  The body will have already established an alternative route for the blood to travel back more efficiently to the heart (deep venous system).  Thus they can be treated without damaging the circulation (treatment actually improves venous circulation).  The chance for a greatly improved appearance is about 80 per cent depending on the severity of the problem. 

What causes the spider and varicose veins?

Since our ancestors decided to stand upright, our leg veins have been faced with the difficult task of taking the blood right up to the heart against the pulling force of gravity.  To do this the leg veins depend on the contraction of the calf and thigh muscles to pump the blood up.  This is why walking is good for your circulation.  So when you walk, the contraction of your leg muscles pumps the blood up.  However, as we know "what goes up must come down" which is what happens to blood in the leg veins.  Therefore to prevent the blood from falling right back down, nature has designed valves in the leg veins which open in only one direction:  upwards.  The valves allow the blood to get through, but when it comes back down, the valves shut and stop the blood from going all the way back down.  The next contraction would then send the blood even higher, till it finally reaches the heart. 

In venous disease, the underlying problem appears to be damage to the valves.  The abnormal reticular veins, for instance, act as "feeders" of the spider veins.  The blood flow in these feeder veins can resemble to a "two-way" street.  In other words, blood in the feeder veins can go back and forth.  This backward flow through the incompetent valves dilates up the smaller veins (medically called "post-capillary venules").  These dilated post-capillary venules are called "spider veins".

The same principle applies to varicose veins.  The abnormal valve cannot stop the blood from rushing back down.  The blood in these veins does not have a lot of oxygen and carries a lot of toxins.  With varicose vein problems, this "toxic" blood is sitting in the legs and cannot get back into the circulation.  This is why patients with varicose veins suffer from night cramps and the legs feel heavy at the end of the day.

Varicose veins occur in both men and women, but more frequently in women.  There is an important genetic factor in the development of venous disease.  It appears that changes in the blood levels of the female hormone estrogen "turns the genes on".  So puberty, pregnancy, breastfeeding and menopause often seem to bring on new abnormal veins.

During pregnancy the enlarged uterus may also restrict blood flow in the veins of the abdomen contributing to the development of varicose veins.  Spider veins may also occur after trauma to a certain area of the body or as a result of wearing tight girdles.  They also appear to be associated with obesity and occupations involving prolonged standing.  When they occur on the face or chest, spider veins may be related to chronic sun exposure, alcohol or exposure to extremes of temperature.

Can vein problems be prevented?

There is no known method of prevention.  Wearing specialized venous support stockings may prevent some dilated blood vessels from developing in some people.  Maintaining a normal weight, regular exercise, avoiding constipation and avoiding wearing high heeled shoes may also be helpful.

SCLEROTHERAPY FOR SPIDER VEINS

How are vessels on the legs treated?

In the majority of cases a procedure called "Sclerotherapy" is used.  This involves injecting a solution, called a sclerosing solution, directly into the blood vessel with a very fine needle.  This procedure has been used for spider veins since the 1930's.  The solution irritates the lining of the vessel causing it to swell and stick together.  Over a period of weeks the vessel fades from view, eventually becoming barely or not at all visible.  Depending on its size, a single blood vessel may have to be injected more than once.  Because larger veins (reticular veins) often underlie spider veins, these vessels must be treated as well. 

Does it hurt?

Different doctors use different solutions.  The amount of discomfort you may feel will depend on the skills of the doctor, the solution used, the concentration of the solution and most importantly your pain tolerance!  In each treatment session many vessels are injected but in general the treatment involves minimal discomfort because of the tiny diameter of the needles.  Some injections give a feeling like a mosquito bite. 

Do I need to wear bandages or stockings?

It is commonly believed that compression should be used following treatment of larger varicose veins.  This minimizes the formation of hematoma (trapped blood) and pigmentation, reduces the number of treatments necessary, reduces the risk of deep venous thrombosis (blood clot) and reduces the possibility of recurrence.  Depending on the opinion of your doctor and the severity of the disease, this can range from 3 days to 3 weeks, (usually about 1 week).

How successful is Sclerotherapy?

After several treatments most patients can expect at least a 75 per cent improvement in the appearance of their legs.  You may initially look worse because of some bruising.  The improvements may be very gradual with some vessels taking up to 3 months to show maximum benefit.  Perfection is seldom achieved (but always strived for!).

What can I expect following my treatment?

*Red, raised areas at the sites of injection.  These should disappear within a day.

*Bruises at injected site.  These will disappear in a few weeks and are probably related to the fragility of blood vessel walls.  Blood trapped in the sclerosed vein may cause the vein to become more noticeable in the first few weeks following treatment, and is an early sign that the treatment has been successful.

*Aching in the leg for the first day or two following treatments.  This is usually relieved by walking.  You may also take Tylenol or Advil to relieve this aching.

Possible side effects of Sclerotherapy:

Even when a highly experienced physician is performing the treatment, there are a number of possible side effects, including the following:

*Staining of the skin:  This is the appearance of brown marks on the skin after treatment.  Some studies showing an incidence as high at 16% at 6 months and 5% at 2 years.  These pigmented areas are mainly composed of hemosiderin, and iron pigment stored in the blood.  This is more likely to occur in patients who have larger veins treated or those patients who have a lot of bruising.  In most cases they disappear completely within a year.  Persistent pigmentation may respond to laser treatment.  In order to minimize this side effect we advise that you do not take any iron supplements (including most multivitamins) before, during or for 3 months after the course of treatment.  You should also not be taking Aspirin, Vitamin E or non-steroidal anti-inflammatories such as "Voltaren" or "Naprosyn".  These medications increase your risk of bruising.

*Matting:  This is the development of networks of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs.  It is reported that about 10% of patients develop these.  Most resolve spontaneously, some resolve with injection treatment, and a few persist.  Matting is more common in patients with extensive surface veins, deep vein problems, of those patients who have a family history of surface veins and in obese patients who have poor muscle tone.

*Ulcers:  Very occasionally (about 1 in 1000) there is the formation of small, painful ulcers at treatment sites within 2 weeks of injection.  These may occur because the solution has escaped into the surrounding skin and sometimes they occur because there is an abnormal connection between small veins and arteries.  They are more common in patients who smoke cigarettes.  They heal slowly and may leave a small pale scar.
*Allergic reactions:  Although on rare occasions (2 per 10,000) such reactions may be serious, they can be treated by immediate injections of adrenaline.  Less serious reactions are treated with antihistamines.  Minor rashes require no specific treatment but you should inform the doctor if they occur.  Rarely, inflammation of the gums (Gingivitis) appears as a reaction to a specific sclerosing solution.  If this occurs, a different solution can be used for subsequent treatments.

*Phlebitis:  This is an inflammation of the treated blood vessels which may also be associated with tender lumps along the line of the treated veins.  This is due to the reaction of the sclerosant on the blood vessel wall and entrapment of "old" blood.  When it occurs to a large or prolonged extent it may be treated by draining the blood out of the painful lumps by a small needle puncture.  Other treatments for this may include anti-inflammatory medication, heat packs, massage with a special cream, compression and regular walking.

*DVT (deep vein thrombosis):  This is a clot in a deep vein.  This is quite rare following sclerotherapy especially if compression and regular daily walking is adhered to.  It is important to stop the oral contraceptive pill prior to Sclerotherapy as it increases the risk of DVT.

*Intra-arterial injection:  This is an extremely uncommon complication which may result in muscle and skin damage.

There are no known long term side effects of sclerotherapy.

Will treated veins recur?

The veins treated adequately by sclerotherapy will not recur.  However, the underlying weakness in your vein walls is not corrected by sclerotherapy and therefore new vessels may appear with time.  It is important to maintain normal body weight, exercise regularly, avoid constipation and minimize the wearing of high heeled shoes to minimize the development of dilated veins.  Ideally, support stockings should be worn every day.  These are not as "heavy" as the stockings used after treatments but offer more support than normal stockings.  A yearly "check-up" is recommended to detect the development of new veins which can then be treated easily.

What are other treatment options apart from Sclerotherapy?

1.         Lasers:  We have a new treatment option called "endovenous laser" which treats large, bothersome varicose veins with no incisions or surgery.
2.         Surgery:  Surgically tying veins off (ligation) or pulling them out (stripping) are other procedures for treating larger leg veins that sometimes cannot be effectively treated by sclerotherapy.

MORE COMMONLY ASKED QUESTIONS

Don't I need these veins?

No.  An incompetent vein does not contribute to effective venous return, and ablating or removing it actually improves venous return.

What about possible future bypass surgery?

A vein with weak, fibrosed and dilated walls is of no use as a bypass graft.

Does sclerotherapy hurt?

Yes, a little, like a mosquito bite (and a little worse if any solution extravasates).

Do they numb my leg or knock me out?

No.

Will they come back?

Other than true treatment failure, no, but most patients require repeat treatments over ensuing years for new varicosities. 

What can I do to prevent new veins after my treatment?

If it's in your genes, you'll always be prone to varicose vein disease, but some things are worth bearing in mind:

•walking (at least 30 minutes three times a week) can slow progression
•graduated class 1 support hosiery can slow progression
•standing still for prolonged periods can accelerate progressio
•estrogens and pregnancy can accelerate progression
•early treatment should be sought for new varicosities


Should I wait until I've had all my children?

Definitely not.  Pregnancy may bring about new veins more quickly, but it will also make the ones already there much worse, both during and after.

Please call us the office at 634-5574 if you have any questions or require any additional information.