SCLEROTHERAPY

WHAT ARE SPIDER VEINS?
The highly visible, blue varicose blood vessels on the thighs, legs and ankles of women and men are unsightly and a cause of concern in most people who have them. Most of the persons having them feel very self-conscious. Many woman with visible "spider veins" or "sunburst" "varicosities" even refuse to wear shorts and many haven't worn shorts for years. Remarkably, some of these women are less than twenty-five years old.

ARE THEY "WORKING" BLOOD VESSELS?
The blue vessels are at best cosmetically annoying and unattractive; they are at worst disfiguring. While the vessels occur in men as well as women, they occur less frequently in men, and in men are somewhat disguised by the hair on men's legs. These "spider veins" are small vessels whose walls have lost their elasticity. They are then left carrying slow moving deoxygenated blood. In other words, they're serving no useful function for the skin or any other tissues in your legs.

WHAT CAUSES SPIDER VEINS?
The causes for these vessels are many, and in any given person, more than one factor may be playing a role in causing "spider veins." The major factors causing "spider veins" on the legs are:

• GENETIC
  In these cases, there is usually a strong family history, including an affected mother, sister(s), and/or daughter(s).
  
• HORMONAL
  There is frequently a worsening during times of heightened estrogen levels, as during pregnancy, during adolescence, or while taking some estrogen-containing medication (such as birth control pills).
  
• PHYSICAL TRAUMA
  There is usually a history of a well remembered blow, or fall, or cut, or surgical procedure at or near the affected sight. Other factors are known to cause "spider veins ", but are much less commonly associated with the veins than the three factors listed above.
  

WHAT CAN BE DONE ABOUT SPIDER VEINS?
Because these vessels are such a nuisance, many different techniques have been developed through the years in order to eliminate them. The major techniques tried on the legs have been electrosurgery and laser surgery, and injection of sclerosing solutions (sclerotherapy). While electrosurgery and lasers work nicely on facial vessels, sclerotherapy has proven to be the best treatment for "spider veins " on the legs. Electrosurgery causes an unacceptable amount of visible scarring. While scarring can occur with sclerotherapy, it happens rarely, and if it does occur, it is usually only at the injection sight. Pulsed-dye lasers may be helpful to reach those vessels that are too small to be injected.

WHAT DO YOU USE FOR SCLEROTHERAPY? WHY?
We use hypertonic saline (23.4sodium chloride, containing no preservatives and no heparin) because of its safety and effectiveness. Allergic reactions cannot occur and it does not cause permanent staining of the skin at the injection sight. Hypertonic saline does cause stinging and short-term (minutes) discomfort in some persons, but it is very safe and very effective. We also use Sotradecol which is a detergent type of sclerosing agent.

WHAT SIZE SPIDER VEINS CAN BE TREATED?
Vessels from less than 1/2 mm to as large as 2 mm can be treated. Pressure over the larger vessels after sclerotherapy causes them to respond better to treatment. Larger vessels can also be treated, but may need surgery, and vascular studies prior to treatment.

WHAT ARE THE SIDE EFFECTS?
Side effects are uncommon. They include brown spots or small crusts or ulcerations at the injection sights. If a brown streak occurs along the course of the treated vessel, it will fade without treatment. Some vessels may require two to four treatments before responding completely. Ankles frequently swell for a few days after they are treated. Thrombophlebitis of the treated vessel occasionally occurs. It's always superficial and responds well to aspirin (or other similar anti-inflammatory drugs), heat, and antibiotics (infrequently needed). Infrequently tiny new vessels develop at treatment sights. They are treated the same way the original vessels were. Rarely, an ulcer may need to be excised in order to speed-up healing.

HOW MANY TREATMENTS WILL BE NEEDED?
The frequency of treatments is determined by the severity of the problem. Treatments are usually done at four to six week intervals. Most patients achieve about a 50% clearing with each treatment.

HOW MUCH IMPROVEMENT CAN I EXPECT?
We expect our patients to get a 75-80% improvement with two treatments. Most do better than that. Sclerotherapy is a very pleasing answer to a nuisance-type problem that will not go away by itself.

CAN BOTH MEN AND WOMEN BE TREATED?
Yes.

HOW LONG MUST I BE OUT OF WORK?
Generally patients go directly back to work. No work should be missed.

WHAT ABOUT SPIDER VEINS ON THE FACE?
Those spider veins can also be treated with very good results with a pulsed-dye laser.