TREATMENT OF LEG VEINS (Spider Veins)
Unwanted leg veins (spider veins), known medically as telangiectasias or superficial varicosities, are dilated skin capillaries. These may become unsightly with time and may also lead to a dull aching of the legs after prolonged standing.
Sclerotherapy is the technique of instilling a specific solution into these vessels (tiny capillaries or larger varicose veins) using a small needle. The solution irritates and destroys the inner lining of the blood vessel so it ceases to carry blood. The body then replaces this damaged vessel with an imperceptible scar. This does not harm the circulation - it improves it by eliminating the abnormal, unnecessary vessel. Several injections may be needed for a specific area of telangiectasia. The procedure has a variable level of pain. Fading of the vessels is a slow process which takes one to six months. The goal is to produce a 75% to 90% improvement.
The cost of vein treatment is dependent on the time spent by your doctor. A rebate from Medicare is only available for larger vessels in the leg, not the superficial ones.
Results of vein treatment cannot be guaranteed, but most patients are very pleased with the cosmetic and functional improvement.
WHAT CAUSES SPIDER VEINS?
No one is totally sure. Certain families are predisposed to this, particularly female relatives. Certain things make spider veins worse: hormone tablets, pregnancy, birth control pills, tight girdles and garter belts, prolonged standing or sitting, and trauma.
HOW DOES IT WORK?
The solution destroys the tiny cells which line the blood vessels, without damage to the surrounding tissues.
HOW SOON WILL THE VESSELS DISAPPEAR?
Each vessel usually requires one to three treatments. The vessels disappear over a period of two weeks to three months. Recurrences may rarely occur over a period of one to five years. This treatment does not prevent new telangiectasia from developing.
ARE THERE CERTAIN VESSELS WHICH TEND TO RECUR MORE COMMONLY?
Yes. They are the type of vessels which occur in a mat of very fine radiating vessels.
HOW OFTEN CAN I BE TREATED?
The same area should not be injected for six to eight weeks to allow for complete healing. Different areas may be treated sooner.
HOW MANY TIMES DOES IT HAVE TO BE DONE?
This varies with the number of areas that have to be injected, as well as the response to each injection. It usually takes one to three injections to obliterate any vessels and 10 to 40 vessels may be treated in any one session.
ARE THERE CERTAIN KINDS OF SPIDER VEINS THAT CANNOT BE TREATED?
Certain types of large varicose veins may not respond readily to sclerotherapy alone. These vessels may require surgery followed later with sclerotherapy. You may be referred to a Vascular Surgeon for complete or partial treatment of these types of large varicose veins. Some of the extremely small vessels (less than a fraction of a mm) may require treatment with a vascular laser.
ARE THERE OTHER METHODS OF TREATING THESE VESSELS?
Three other methods are used:
- Laser surgery - Cutera Excel V Laser.
- Electrodessication - this method produces a non-specific destruction of both the vessel and overlying skin, resulting in a greater incidence of scarring.
- Surgical ligation or circumsuture - this operative procedure always results in a scar and is best reserved for large varicose veins.
IS THERE ANY WAY TO PREVENT THEM?
- The use of support hose may be helpful.
- Regular exercise and weight reduction may also be helpful.
WHAT ARE THE SIDE-EFFECTS?
- Slight blistering may occur around the injected vessels and will resolve in a day or so.
- 10-30% of patients develop a small freckle-like tan to brown spot around the injected vessel and along its course. This usually resolves in 80% of these patients within 3-6 months. A few patients will have a persistent freckle for up to a year.
- Fine new blood vessels (neo-vascularization) develop in approximately 10% of cases, around the injection sites. These will usually persist for six months and have faded away by one year.
- Slight stinging or burning may occur with injection of certain types and concentrations of solutions in some areas.
- Sometimes a clot develops at the injection site (especially if the recommended pressure stockings are not worn as advised). This clot will not cause internal problems, but its removal within two weeks of injection will speed the healing process and decrease the incidence of "freckling".
- Swelling over the injection site may rarely occur. It is particularly common when patients have jobs in which they stand for long periods of time or when vessels in the ankles are injected. The swelling is not dangerous but occasionally must be treated with elevation and compression dressings.
- A small superficial ulceration of the skin overlying the injected vessel may occur. This does not usually leave a scar but needs to be seen as soon as possible by your doctor.
- Superficial thrombophlebitis, an irritation of the injected vessel, occurs in less than one in a thousand patients. It may have to be treated with anti-inflammatory agents and compression stockings.
- Allergy may occur but is rare.
PREVENTION OF SIDE-EFFECTS
Your doctor may apply compression bandages or recommend compression stockings to you for decreased side-effects. Your doctor will advise if your veins require such treatment.
WHAT SHOULD I DO BEFORE MY APPOINTMENT FOR TREATMENT?
- Advise Dr Hills if you take Aspirin and so-called blood thinning drugs prior to your appointment
- Do not shave your legs for two days prior to appointment.
- Eat a light breakfast or lunch an hour or so prior to appointment
- Bring shorts to wear during the procedure and slacks to wear out of the office.
- Do not apply cream to your legs on the day of treatment.
WHAT SHOULD I DO AFTER THE PROCEDURE?
- Walk for 30 minutes immediately following the injections.
- If possible, do not drive home yourself. If you have to drive, keep the legs moving and make frequent stops for walking (every 20 minutes).
- Maintain normal daytime activities.
- Walk at least an hour a day - the more the better.
- No hot baths for two weeks.
- Avoid standing without moving about. If you must stay in one place, move feet and toes frequently.
- If the legs become painful after the injection, walk.
- Cover legs with a plastic bag when showering.
- Avoid strenuous physical activity (aerobics) for the first 48-72 hours.