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WHAT ARE SPIDER VEINS?
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.
Spider veins can
occur on the legs and the face.
The overwhelming number of female patients with
this condition seek treatment because of the embarrassment of
wearing skirts, shorts, and bathing suits or veins on their nose
or cheeks.
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.
TREATMENT OF FACIAL SPIDER VEINS
Since simple electrocautery tends to be sufficient for most
facial telangiectasias and is most cost effective, this is an ideal
point to begin with.
Injectable anesthesia is not typically used during
electrocautery since it can cause transient skin whiteness,
concealing their location.
 If a topical is necessary,
a topical anesthetic agent may be applied
to help improve comfort during the procedure.
Electrocautery is performed using a very tiny needle that
literally zaps along the length of the blood vessel. There may be some swelling and redness for a day or 2.
Depending upon the number of blood vessels present, 1 or 2
treatments are all that it should take. The session probably
will last between 15-30 minutes. Remember, just like other "age-related" growths, anyone
prone to growing telangiectasias will probably continue to make
more as time goes on. Prepare for some maintenance every now and
then.
TREATMENT OF LEG SPIDER VEINS
Those cluster of blue and purple spider veins
can be permanently eliminated with an easy office procedure
called injection therapy or sclerotherapy. A tiny needle is used to inject an
irrigating solution directly into the veins causing them to
close and simply disappear. Injection therapy is the most
effective treatment available for spider veins. For many
people, only three to four treatments are needed to remove all
their spider veins.
HOW DOES SCLEROTHERAPY WORK?
A very small needle is used to inject a sclerosing solution into
a varicose or "spider" vein. Once
injected the cells that line the vein wall (endothelium) will
become irritated, inflamed and damaged. External compression is
applied using cotton balls, tape and compression bandages for 12
to 24 hours. The
compression causes the vein walls to seal together and the vein
no longer can transport blood. Your body will then break down
and absorb the damaged vein. When healing is complete the vein
is no longer visible. The process is very similar to how your
body heals a bad bruise. "Spider" veins do not have any useful
function and eliminating them wil l
not affect your circulation. Reducing or eliminating varicose
veins can improve your circulation and symptoms of heaviness,
aching and fatigue.
THE PROCEDURE
A typical sclerotherapy
session is relatively quick, lasting only about 15 to 45
minutes. After changing into shorts, your legs may be
photographed for your medical records. You will be asked to lie
down on the examination table and the skin over your spider
veins will be cleaned with an antiseptic solution.
Approximately one injection is administered for
every inch of spider vein - anywhere from five to 40 injections
per treatment session. A cotton ball and compression tape is
applied to each area of the leg as it is finished.
As the procedure
continues, you will feel small needle sticks and possibly a mild
burning sensation. However, the needle used is so thin and the sclerosing
solution is so mild that pain is usually mild. Patients can have
pain, ranging from a dull throbbing pain to a burning sensation.
The larger vessels are more likely to cause discomfort, although
smaller blue veins have been shown to cause pain.
HOW MANY TREATMENTS ARE NEEDED?
The number of treatments needed varies from patient to patient
depending on the type, size and quantity of veins to be treated.
Varicose veins and "spider" veins may require multiple injection
sessions. Subsequent treatments are usually scheduled every four
to six weeks to allow time for the body to respond to the
treatment. It is important to realize that the best results
require patience. It takes time for your body to respond to the
injections. It is important to follow the post-treatment
instructions to optimize your results. Your body will continue
to heal and "fade" injection sites for months after treatment.
WHAT TO EXPECT:
Sclerotherapy can enhance your
appearance and your self confidence, but it's unrealistic to
believe that every affected vein will disappear completely as a
result of treatment. Your legs will look
worse before they look better. Most people will notice a
dramatic improvement approximately four weeks after their
initial treatment. Maximal improvement often takes several
months and several
 treatments. There is no guarantee sclerotherapy will be effective in every case. Some veins and
areas will need to be retreated. Recurrence of the same vein
treated rarely occurs.
You should also be aware that the
procedure treats only those veins that are currently visable; it
does nothing to permanently alter the venous system or prevent
new veins from surfacing in the future.
You should be aware that your
treated veins will look worse before they begin to look better.
When the compression dressings are removed, you will notice
bruising and reddish areas at the injection sites. The bruises
will diminish within one month. In many cases, there may be some
residual brownish pigmentation which may take up to a year to
completely fade.
HOW
SUCCESSFUL IS SCLEROTHERAPY?
After several treatments, most patients can expect a 50 percent
to 90 percent improvement. However, fading is gradual, usually
over months. Disappearance of spider veins is usually achieved,
but similar veins may appear in the same general area.
ARE
THERE SIDE EFFECTS TO SCLEROTHERAPY?
Even with a highly
experienced physician performing the treatment, there are some
possible side effects. They include:
Itching-you may experience itching around the area
injected. If this occurs, it is usually mild and lasts for one
to two days.
Stinging or pain at
the sites of injection, swelling of the ankles or feet or muscle
cramps. Muscle cramps almost always occur when the injection
takes place in the ankle area. These usually go away within 10
to 15 minutes after injection.
Red, raised areas at
the sites of injection. These should disappear within a day or
so.
Brown lines or spots
on the skin at the sites of treated blood vessels. Probably made
up of a form of iron in the blood, these darkened areas may
result when blood escapes from treated veins. Approximately
20-30% of patients treated note the discoloration, which is
lighter and less obvious than the vein being treated. The hyperpigmentation usually fades in a couple weeks, but may
take several months to a year to totally resolve. There is a
one-percent incidence of hyperpigmentation continuing after one
year.
Matting-Development
of groups of fine red blood vessels near the sites of injection
of larger vessels, especially on the thighs. About a third of
patients develop these; most disappear by themselves, some go
away with injection treatment or laser therapy, a few may last.
Small, painful ulcers
at treatment sites either immediately or within a few days of
injection. Sometimes these occur because some of the solution
has escaped into the surrounding skin. These can be successfully
treated, but it is necessary to inform the physician of them
immediately.
Bruises at the site
where the needle went into the skin. These will disappear in a
few weeks and are probably related to the thinness of blood
vessel walls.
Allergic reactions
to certain sclerosing solutions. Although, on rare occasions,
such reactions may be serious, they can be treated by immediate
injections of epinephrine. Less serious reactions are treated
with antihistamines.
Inflammation of treated
blood vessels. This is very unusual but when it occurs it is
treated with medications such as aspirin, compression,
antibiotics or heat.
SCLEROTHERAPY POST TREATMENT
INSTRUCTIONS:
COMPRESSION-cotton balls, tape and elastic
bandages provide local
compression over each area injected. Proper compression is very
important because it minimizes the blood re-entering the
injected vein, decreases the incidence of post sclerotherapy
hyperpigmentation and telangiectatic matting and improves venous
blood flow. The cotton balls and tape can be very uncomfortable
and may even irritate and blister sensitive skin. After the
first 24 hours the hose, cotton balls and tape may be removed.
BATHING-a shower is allowed after the first 48
hours. Hot baths, hot tubs and saunas should be avoided for two
weeks after sclerotherapy to avoid venous dilatation.
HYPERPIGMENTATION-if you develop hyperpigmentation
after sclerotherapy you should apply sun block to those areas
when sun exposure is anticipated to avoid increasing the
hyperpigmentation. Continue to use sun block until the
hyperpigmentation has resolved.
DRIVING-you may drive immediately after your
treatment. If your trip home is longer than an hour we recommend
you stop hourly to stretch your legs.
ACTIVITY-in most cases, you may return to work and
resume normal activity after treatment. Please take a 15-minute
walk immediately following your treatment. This will help
circulate the solution that was injected. Walking is encouraged;
it promotes efficient venous circulation. Avoid sitting and
standing for extended periods and elevate your leg(s) above the
level of your heart when possible for the next two to three
days. If large varicose veins were injected, your doctor may
recommend you stay off your feet with your leg(s) elevated for
the rest of the day. Avoid high impact aerobics, jogging,
running, leg weight lifting and sit-ups for one to two weeks
after each injection treatment.
MEDICATIONS-do not use Aspirin or Ibuprofen
products for several days after each treatment to reduce bruising.
Acetaminophen (Tylenol) can be used if you experience any
discomfort from sclerotherapy.
FOLLOW-UP-subsequent treatments are usually every
four to six weeks. If you notice dark knots or cords at your injection
sites please call our office; you may need to return sooner to
have these areas aspirated. Remember it is important to call our
office if you have any questions or concerns before or after
your sclerotherapy treatment. Please keep your follow up
appointment after treatment. It is important for the physician
to assess the results you achieved from each treatment. If you
need to cancel or reschedule your sclerotherapy treatment or
follow up appointment, please give our office at least 72 hours
notice.
Copyright © 1998 -
2006, Test America
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