Spider Vein Treatment and Removal

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What is Sclerotherapy?

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.

How successful is sclerotherapy in treating varicose and spider veins?

Sclerotherapy works well for most patients. After several treatments, most patients can expect an 80 - 90 percent improvement. Fading will gradually occur over months. Disappearance of treated spider veins is usually achieved, but similar veins may appear in the same general area.

It is estimated that as many as 50 percent to 80 percent of injected veins may be eliminated with each injection session. A few (less than 10 percent) of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions or a different method, such as laser therapy, may be tried.

In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months. If the veins respond to the treatment, they will not reappear. However, new veins may appear over time. If needed, you may return for injections.

How is sclerotherapy performed?

A chemical solution is injected into veins to cause them to collapse and form scar tissue that permanently closes them. Nearby veins take up re-routed blood flow. Sclerotherapy requires multiple treatments to close off all affected veins. Additional treatments may be needed from time to time as new enlarged veins appear. Side effects of sclerotherapy may include slight swelling, bruising, and redness and itching at injection sites.

Can sclerotherapy or lasers be used on all skin types?

Yes. All skin types and skin colors respond well, although some skin types require special lasers.

Types of veins

There are four categories of veins which are of interest in an examination by a sclerotherapist: deep veins, superficial veins, perforator veins, and spider veins. The deep veins are buried beneath skin, muscle, and bone and cannot be seen except during surgery. The superficial veins are the ones you can see just under the skin. The perforator veins connect the two systems. Reticular veins are incompetent superficial veins. Varicose veins are superficial veins which are not only incompetent, but are swollen, elongated (and thus serpentine) as a result. The most fundamental problems must be fixed first and these are, in order: incompetent deep veins, incompetent perforator veins, incompetent superficial veins (reticular and varicose veins), and finally the spider veins.

What you need to do before the procedure

Prior to sclerotherapy, certain medications should be avoided. Tetracycline or Minocin, both antibiotics, may possibly cause a staining of the skin if taken 7 to 10 days before or after sclerotherapy. Ask your doctor about other antibiotic medications you may take, or ask for safe guidelines for discontinuing these medications. If you are required to take an antibiotic before any invasive procedure, such as dental procedures, colonoscopy or surgery, please inform your physician.

Do not take aspirin, ibuprofen (Advil) or other anti-inflammatory medications for 48 hours before and after sclerotherapy, because these medications may interfere with the action of the sclerosing agent. Tylenol is permitted. Ask your doctor for specific guidelines before discontinuing any medication.

Prednisone also decreases the effectiveness of the sclerosing agent. Ask the doctor who prescribed your prednisone if it can be safely discontinued for 48 hours before the sclerotherapy procedure.

No lotion should be applied to the legs before or after sclerotherapy. It is recommended that you bring a pair of shorts to wear during the procedure.

If you have compression hosiery from previous treatments, please bring them with you so we can make sure they will provide adequate support after the procedure.

Are there side effects to sclerotherapy?

There are some possible side effects. They include:

Stinging or pain at the sites of injection, swelling of the ankles or feet, or muscle cramps.
This usually occurs when hypertonic saline solution is used. Hive-like reactions usually go away within 10 to 15 minutes after injection.
Red, raised areas at the sites of injection. These are similar to hives and the response should disappear within a day or so.
Brown lines or spots on the skin at the sites of treated blood vessels. Darkened areas may result when blood escapes from treated veins and are probably formed from iron in the blood. These dark areas occur more often in patients who have larger veins treated or those patients that tan easily. In most cases, they disappear within a year, but they may last longer.
Development of groups of fine red blood vessels near the sites of injection of larger vessels. About one-third of patients develop groups of vessels especially on the thighs. Most disappear by themselves, some need additional injection treatments or laser therapy, a few may last.
Small, painful ulcers at treatment sites either immediately or within a few days of injection. These occur when some of the solution escapes into the surrounding skin or enters a small artery at the treatment site and can be successfully treated, but it is necessary to inform the dermatologist immediately.
Temporary bruises. Bruises usually occur after laser treatments and are probably related to the thinness of blood vessel walls. They usually disappear in a few weeks. Occasionally, bruising is seen with sclerotherapy.
Allergic reactions to sclerosing solutions. Although such reactions are uncommon, they can be treated. Inform your dermatologist immediately.
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.
Lumps in injected vessels. This is coagulated blood and is not dangerous. The dermatologist may drain the blood from these areas a few weeks after injection.
Burning with discoloration of the skin.

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