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Common Conditions -
Spider and Varicose Veins
Sclerotherapy
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.
Today, many doctors 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.
What Are Spider Veins?
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
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.
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
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 the 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 Treatment 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.
Your New Look
Most patients are pleased with the difference
sclerotherapy makes. The skin of your legs will
appear younger, clearer and more
healthy-looking. If you've been wearing long
skirts and slacks to hide your spider veins,
you'll now be able to broaden your fashion
horizons. Often, patients are surprised at the
dramatic difference in appearance between a
treated leg and an untreated one.
Although sclerotherapy will obliterate the
noticeable veins for good, it's important to
remember that treatment will not prevent new
spider veins from emerging in the future. As
time passes, you may find that you need
"touch-ups" or full treatments for new veins
that surface. But even if you choose not to have
further sclerotherapy, your legs will look
better than if you never had treatment at all.
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