Millions of men and women are bothered by spider veins - those small yet unsightly clusters of red,
blue or purple veins that most commonly appear on the thighs, calves and ankles. In fact,
it's estimated that at least half of the adult female population is plagued with this common
cosmetic problem.
Today, many plastic surgeons are treating spider veins with sclerotherapy. In this rather
simple procedure, veins are injected with a sclerosing solution, which causes them to collapse
and fade from view. The procedure may also remedy the bothersome symptoms associated with spider
veins, including aching, burning, swelling and night cramps.
Although this procedure has been used in Europe for more than 50 years, it has only become
popular in the United States during the past decade. The introduction of sclerosing agents that
are mild enough to be used in small veins has made sclerotherapy predictable and relatively
painless.
If you're considering sclerotherapy to improve the appearance of your legs, this brochure will
give you a basic understanding of the procedure - when it can help, how it's performed and what
results you can expect. It won't answer all of your questions, since a lot depends on your individual
circumstances. Please ask your doctor if there is anything about the procedure you don't understand.
Spider veins on the leg usually appear in one of three patterns: (a) simple linear
(b) arborizing, which appear branch-like, and (c) spider, which appear as a cartwheel
shape with a dark center point.
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.
Varicose veins differ from spider veins in a number of ways. Varicose veins are larger - usually
more than a quarter-inch in diameter, darker in color and tend to bulge. Varicose veins are also
more likely to cause pain and be related to more serious vein disorders. For some patients,
sclerotherapy can be used to treat varicose veins. However, often surgical treatment is necessary
for this condition.
The best candidates for Sclerotherapy
Women of any age may be good candidates for sclerotherapy, but most fall in the 30-to-60 category.
In some women, spider veins may become noticeable very early on - in the teen years. For others,
the veins may not become obvious until they reach their 40s.
If you are pregnant or breastfeeding, you may be advised to postpone sclerotherapy treatment. In
most cases, spider veins that surface during pregnancy will disappear on their own within three
months after the baby is born. Also, because it's not known how sclerosing solutions may affect
breast milk, nursing mothers are usually advised to wait until after they have stopped breastfeeding.
Spider veins in men aren't nearly as common as they are in women. Men who do have spider veins
often don't consider them to be a cosmetic problem because the veins are usually concealed by
hair growth on the leg. However, sclerotherapy is just as effective for men who seek treatment.
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What to expect from Sclerotherapy
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. After each
sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required to
achieve optimal results.
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.
Before you decide to have sclerotherapy, think carefully about your expectations and discuss
them with your doctor.
Risks related to treatment
Serious medical complications from sclerotherapy are extremely rare when the procedure is
performed by a qualified practitioner. However, they may occur. Risks include the formation
of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing
solution and skin injury that could leave a small but permanent scar.
A common cosmetic complication is pigmentation irregularity - brownish splotches on the affected
skin that may take months to fade, sometimes up to a year. Another problem that can occur is
"telangiectatic matting," in which fine reddish blood vessels appear around the treated area,
requiring further injections.
You can reduce the risks associated with treatment by choosing a doctor who has adequate training
in sclerotherapy and is well versed in the different types of sclerosing agents available. A
qualified doctor can help you select which type of sclerosing medication is most appropriate
for your needs.
Planning your treatment
During your initial consultation, your legs will be examined. Your doctor may draw a simple
sketch of your legs, mapping out the areas affected by spider veins or other problems. During the
examination, you will be checked for signs of more serious "deep vein" problems, often indicated
by swelling, sores, or skin changes at the ankle. A hand-held Doppler ultrasound device is
sometimes used to detect any backflow within the venous system.
If such problems are identified, your surgeon may refer you to a different specialist for further
evaluation. Problems with the larger veins must be treated first, or sclerotherapy of the surface
veins will be unsuccessful.
Your doctor will ask you about any other problems you may have with your legs, such as pain, aching,
itching or tenderness. You will also be asked about your medical history, medications you take, or
conditions that would preclude you from having treatment. Individuals with hepatitis, AIDS or other
blood-borne diseases may not be candidates for sclerotherapy. Patients with circulatory problems,
heart conditions, or diabetes may also be advised against treatment.
It's important to be open in discussing your history and treatment goals with your doctor. Don't
hesitate to ask any questions or express any concerns you may have. Your doctor should explain the
procedure in detail, along with its risks and benefits, the recovery period and the costs. (Medical
insurance usually doesn't cover cosmetic procedures.)
Preparing for your procedure
You will receive specific instructions from your physician on how to prepare for your treatment.
Carefully following these instructions will help the procedure go more smoothly.
You'll be instructed not to apply any type of moisturizer, sunblock or oil to your legs on the day
of your procedure. You may want to bring shorts to wear during the injections, as well as your
physician-prescribed support hose, and slacks to wear home.
When scheduling your procedure, keep in mind that your legs may be bruised or slightly discolored
for some weeks afterward. You probably won't be comfortable wearing shorts, a swimsuit or a mini
skirt until after your legs have cleared up a bit.
Where your surgery will be performed
Sclerotherapy of spider veins is a relatively simple procedure that requires no anesthesia, so it
will be performed in an outpatient setting, most likely your doctor's office.
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. Using one hand to stretch the skin taut, your doctor or nurse will begin
injecting the sclerosing agent into the affected veins. Bright, indirect light and magnification
help ensure that the process is completed with maximum precision.
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.
During the procedure, you may listen to music, read, or just talk to your practitioner. You will be
asked to shift positions a few times during the process. 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 minimal.
After your treatment
In addition to the compression tape applied during the procedure, tight-fitting support hose may
be prescribed to guard against blood clots and to promote healing. The tape and cotton balls can
be removed after 48 hours. However, you may be instructed to wear the support hose for 72 hours
or more.
It's not uncommon to experience some cramping in the legs for the first day or two after the
injections. This temporary problem usually doesn't require medication.
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.
Getting back to normal
Although you probably won't want to wear any leg-baring fashions for about two weeks, your
activity will not be significantly limited in any other way from sclerotherapy treatment.
You will be encouraged to walk to prevent clots from forming in the deep veins of the legs.
However, during the period of time to complete your treatment program, prolonged sitting and
standing should be avoided, as should squatting, heavy weight lifting and "pounding" type
exercises, including jogging.
A one-month healing interval must pass before you may have your second series of injections
in the same site. After each treatment, you will notice further improvement of your legs'
appearance.
Varicose veins are a very common problem, generally appearing as twisting, bulging rope-like cords
on the legs, anywhere from groin to ankle. While many people have heard of varicose veins, very few truly
understand their underlying cause, and the potential they have for developing into a serious medical issue.
Varicose veins affect an estimated 40% of women and 25% of men. Factors leading to varicose veins include heredity,
gender, pregnancy, age and other factors. Some factors may speed up the development of this disease and make the
veins worse, including prolonged standing, obesity, hormone levels, and physical trauma.
Traditionally, varicose vein treatment has been painful surgery (called ligation and stripping). Now, endovenous laser
treatment (EVLT®) provides a proven, minimally-invasive alternative that allows patients to return to their everyday
lives immediately. Varicose veins (and sometimes spider veins) are usually a symptom of chronic venous insufficiency,
a disease that causes blood to flow backward in the veins, making them bulge and twist down the leg. Venous
insufficiency (also called venous reflux) can occur throughout the venous system, but occurs most frequently in the
great saphenous vein, small saphenous vein, and other veins of the superficial venous system in the lower legs.
One-way valves in the veins of the legs typically ensure that blood is carried toward the heart and prevent it from flowing
backward (down the leg) and pooling. Valve failure leading to chronic venous insufficiency can be caused by multiple
factors:
Injury or other trauma
Weak vein walls that dilate under normal pressures
Genetically abnormal valves
Normal veins whose vein walls are weakened by hormones (as in pregnancy)
Varicose vein treatment may be indicated when valves fail, blood flows backward (or downward) in the veins, and pressure increases
in the venous system below. This increased pressure causes many of the symptoms of venous insufficiency as well as
potentially (over time) causing the failure of additional valves below the original failed valve.
What are the symptoms? Will they get worse?
In addition to the visual appearance, many patients may experience one or more of the following leg symptoms:Pain (an aching or cramping feeling,
Heaviness/Tiredness, Burning or tingling sensations, Swelling/Throbbing, Tender areas around the veins
If you experience symptoms and delay treatment, your symptoms may progress onward to more serious complications including:
Inflammation (phlebitis), Blood clots (e.g., DVT),Ankle sores or skin ulcers, Bleeding
If you are experiencing any of the above, consult your physician, as treatment may be required.
Treatment alternatives for varicose veins
Your physician will usually try methods that don’t involve surgery first to relieve your symptoms. These may include preventive techniques or
the use of compression stockings. If your varicose veins do not respond to this conservative therapy, more active treatment may be required,
including EVLT.
What does EVLT® stand for?
EndoVenous Laser Treatment
Who is a candidate for Laser Vein Therapy?
If you can answer YES to any of the below questions, you may be a candidate for treatment.
Have you or anyone in your family previously been diagnosed with varicose veins or venous reflux?
Do you have varicose veins which exhibit any of the following characteristics: Large, bulging veins on your legs; Swollen, red, or warm to the touch; Skin discoloration or texture changes
Are you experiencing any of the following symptoms in your legs, ankles, or feet: Pain (an aching or cramping feeling); Heaviness/Tiredness; Burning or tingling sensations; Swelling; Tender areas around the veins; Sores or skin ulcers near ankle
Have you previously had skin ulcers on the leg (or areas that were slow to heal)?
Have you previously attempted conservative treatments without success (e.g. exercise, weight loss, elevating legs, avoiding long periods of standing/sitting, compression stockings)?
How does the procedure actually work?
A laser fiber is fired inside and along the length of your faulty, varicose vein. The laser energy
damages the vein walls, shrinking them closed so that blood can no longer flow through.
Are the treatments painful?
Laser Vein Therapy is usually not painful and does not require anesthesia. Some patients may experience a burrning or tingling
at the treatment site. For persons with very sentitive skin, a topical anesthetic can be used before the laser vein therapy
treatments are administered.
How successful is EVLT®?
Clinical data with up to 5 years of follow-up show success rates of 93-98%. This is much higher than surgical
ligation and stripping, radiofrequency electrosurgery, and injection sclerotherapy. Market researchers predict
that, based on its superior efficacy and lower morbidity, endovenous laser treatment will soon become the new
‘gold standard’.
Once the vein is treated, where does the blood go?
Once a vein is treated and closed, the blood that would have flowed through this vein now flows through other
healthy veins. There are several veins in the venous system in the legs. Anywhere the system "fails" (spider or varicose veins),
needs repairing to improve circulation.
Will insurance cover EVLT® for everyone?
No. Carriers will cover EVLT® only when medically necessary. Patients must demonstrate symptomatic venous reflux
disease. That is:(1)Pain, swelling, leg cramps, ulcers, bleeding from varicosities and (2)Presence of reflux on ultrasound scan
NBC Nightly News June 2005
Todays Health December 2004
CoZmedic Surgery Associates LLC
1515 N. Harlem Ave.
Suite 309
Oak Park, IL 60302
