Sclerotherapy (Spider Veins)
Sclerotherapy is a medical specialty in which the doctor treats cosmetic and functional vein disorders. Many types of doctors deal with vein disorders, however not all doctors who deal with veins really understand how to do the job properly so that the problem is solved and does not return.
Most people come to a sclerotherapist for one of two reasons: appearance and discomfort. Probably the majority are concerned about the cosmetic appearance of "spider" veins just under the skin. True spider veins are fed from the arterial system and when compressed they refill from the center giving the impression of a spider spreading its legs.
What Are Spider Veins?
Spider veins are small, thin veins that lie close to the surface of the skin. Although these smaller 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.
Millions of 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.
How is Sclerotherapy performed?
Sclerotherapy is performed in a doctor's office. In most cases, a 23 percent sodium chloride sterile solution mixed with lidocaine (a local anesthetic) and heparin is injected into a very fine needle directly into the blood vessel, using a very fine needle. A solution without lidocaine is available for people who are allergic to lidocaine. The number of varicose veins injected in one session is variable, depending on the size and location of the veins, and the patient's overall medical condition.
Sotredecol, or STS, is a chemical irritant that causes the vein to shut down. And it can be mixed with air to create a foam. This is also an effective treatment for saphenous reflux. Mild discomfort may occur, and a cramping sensation may be felt for 1 to 2 minutes when larger varicose veins are injected. The sclerotherapy procedure itself takes about 30 to 45 minutes.
What are side effects of sclerotherapy?
Certain side effects may be experienced after sclerotherapy. Larger injected varicose veins may become lumpy and hard for several months before resolving. Raised red areas may appear at the injection sites and should disappear within a few days. Brown lines or spots on the skin may be noted at the site of the injection, possibly caused by a form of iron that escapes from the injected veins. In most cases, they disappear within 3 to 6 months, but can be permanent about 5 percent of the time. Bruising may occur around the injection site and can last several days or weeks.
What should I bring to my appointment?
You will receive specific instructions on how to prepare for your spider vein treatment. Carefully following these instructions will help the procedure go more smoothly. You'll be instructed not to apply any type of moisturizer, sun block 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 or sweatpants 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.
What should I expect after sclerotherapy treatment?
After treatment you will be able to drive yourself home. You may resume your regular activities and are encouraged to walk. You will be instructed to wear support hosiery or compression wraps to compress the treated vessels. Support stockings purchased from a department store may not be adequate if a heavy compression stocking is prescribed.
After the procedure, avoid aspirin, ibuprofen and other anti-inflammatory medications for at least 48 hours. Tylenol may be used if needed. Do not take hot baths or sit in a whirlpool or sauna, or apply hot compresses or any form of heat to the injected areas for 48 hours after treatment. In addition, avoid direct exposure to sunlight (sun bathing and tanning beds) jogging, high-impact aerobics and swimming for 7 to 10 days after the procedure.
Showers are permitted, but the water should be cooler than usual. The injection sites may be washed with a mild soap and lukewarm water.
Peyman Ghasri (Encino, California) Doctor Profile on SuperDoctors.com, practicing in Dermatology. Contact Doctor Peyman Ghasri.