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Answers To Your Questions
About Spider Veins
WHAT CAUSES SPIDER VEINS?
Spider veins are dilated blood vessels located in the skin. No one is certain what causes spider veins but there is usually a family history of such problems. Pregnancy, estrogens, birth control pills, tight clothing, girdles and garter belts, prolonged standing/sitting, crossing one’s legs, injuries and sun exposure are thought to contribute to their formation.
IS THERE ANY WAY TO PREVENT THEM?
The use of support hose, weight reduction, avoidance of birth control pills and estrogens, and regular exercise may be of benefit. Sunscreens to prevent excessive sun exposure are recommended.
WHAT SYMPTOMS DO THEY PRODUCE? ARE THEY DANGEROUS?
Ordinarily, spider veins cause no symptoms and are of concern because of their appearance. Some patients report burning, stinging, dull aching and fatigue in the legs after prolonged standing. There is no danger associated with them.
HOW CAN SPIDER VEINS BEST BE TREATED?
The best treatment for spider veins is injection sclerotherapy
WHAT IS SCLEROTHERAPY AND HOW DOES IT WORK?
Sclerotherapy is a specialized treatment for the elimination of unwanted veins. It is the most effective and least expensive way to treat spider and smaller varicose veins. The technique consists of using a tiny needle to inject a “sclerosing” solution into the veins. The vein becomes gradually replaced with scar tissue. Since the vein no longer carries blood it "disappears." This does not harm the circulation and may improve it by eliminating abnormal veins.
Does it hurt?
Sclerotherapy takes years of experience to master. In the hands of a competent surgeon, and using advanced techniques and local anesthesia, discomfort is minimized, and results are optimized.
How Long Does It Take?
Most sessions last 30 - 45 minutes. Normal activities can be immediately resumed. Two to three sessions about one month apart are usually required, although in some cases just one is needed.
HOW SOON DO THE VEINS FADE?
Fading of the veins is a slow process that may take up to 6 months. Some improvement is usually seen after one month. Several injections are usually needed if there are large clusters of veins. This treatment does not prevent new spider vein formation. Results of treatment cannot be guaranteed, but most patients are very pleased with the cosmetic and functional improvement.
HOW MANY INJECTIONS ARE REQUIRED? DO THE INJECTIONS HURT?
This varies with the number of veins injected, as well as the response to each injection. It may take multiple injections to obliterate any vein, and as many as 70 injections can be done in any one session. Sessions are usually scheduled about three weeks apart, but in some cases can be done weekly. The injections are well tolerated. Slight stinging or burning may occur with injection of certain types and concentrations of solutions in certain areas. There may also be some momentary muscle cramping.
ARE THERE CERTAIN KINDS OF VEINS THAT CAN'T OR SHOULDN'T BE INJECTED?
Larger varicose veins can be injected but in many cases these are best treated by minor surgery followed by sclerotherapy. Some tiny spider veins are too small for injection.
HOW MUCH DOES INJECTION SCLEROTHERAPY COST?
The initial consultation fee of $100.00 includes a thorough vascular examination. This fee is reimbursed at the first injection session if scheduled within one month. Venous anatomy is described and measures that can be taken to prevent future vein problems are discussed. The initial consultation and the injection treatments are not covered by insurance and payment is required at the time of service. Charges relate to the number of veins that need to be injected. The average cost is about $350.00 per session. Elastic compression stockings will be prescribed at the initial consultation and must be obtained prior to the first treatment session. The stockings cost from $15 to $125 depending on the type required or desired. A list of vendors will be provided. These stockings are washable and can last for years.
WHAT ABOUT LASER THERAPY FOR SPIDER VEINS?
Though lasers are effective for various facial cosmetic procedures and for hair removal, they are not reliably effective for eliminating spider and varicose veins. Despite this ineffectiveness, advertisements for laser treatment of veins frequently appear in newspapers and on radio. The following points should be kept in mind when considering laser therapy:
• Laser treatment in most cases is more painful than sclerotherapy.
• Although much more expensive, laser therapy is frequently ineffective.
• Lasers oftentimes cause burns and permanent scarring.
• Proponents of laser vein treatment are usually not Vascular Specialists but rather physicians whose only qualification to treat veins is a brief period of training provided by laser manufacturers and access to an expensive laser unit.
WHAT OTHER METHODS OF TREATMENT ARE AVAILABLE FOR SPIDER VEINS?
• Electrodessication - this treatment causes non-specific destruction of the vein and overlying skin, thus resulting in more scarring. It is not recommended.
• PhotoDerm - This is a technique that uses flash heat to desiccate (dry out) spider veins. The results are not consistently good and are certainly no better than injection sclerotherapy. It is an expensive mode of therapy.
WHAT ARE THE POSSIBLE SIDE EFFECTS?
1. Blistering may occur around the injected vessels and resolves in a day or so.
2. Some patients develop brown stains around the injected veins. This staining disappears usually within 3 to 6 months although this may persist for up to a year or more.
3. Sometimes blood gets trapped in the injected veins (especially if recommended compression stockings are not worn). This causes no problems and can be removed at the next session.
4. Swelling at injection sites may occur. This is not dangerous and is treated with elevation and elastic stockings.
5. Ulceration of the skin overlying the injected vein may occur in fewer than 2% of patients. The ulcers heal slowly over several months and leave a dark scar that in most cases fades over time.
6. Superficial phlebitis, an irritation of the injected vein, occurs in less than 1 per 1000 patients. Treatment is with anti-inflammatory medicine and compression stockings.
7. Neovascularization, development (usually temporary) of tiny new spider veins, may occur at the sites of injection in about 15% of cases.
WHAT SHOULD I DO BEFORE MY APPOINTMENT FOR TREATMENT?
1. Discontinue aspirin and any blood thinning drugs one week prior to your appointment but first check with your prescribing physician.
2. Don't shave your legs for 2 days prior to your scheduled treatment. Do not use any skin creams or lotions on the day of your treatment.
3. Eat a light breakfast or lunch an hour or so before your appointment for injections.
4. Bring "short shorts" to wear during the treatment session, and loose slacks to wear over your elastic compression stockings after treatment is completed. The elastic stockings will be easier to get on if you slip them over a pair of regular panty hose.
5. Optional: You may wish to bring your iPod or other mp3 player. It is helpful in making you more relaxed.
6. Optional: Take 400 mg of Ibuprofen before you arrive at the office. This will lessen the minor discomfort associated with sclerotherapy.
WHAT SHOULD I DO AFTER THE INJECTIONS?
1. Walk briskly for 15 minutes immediately upon leaving the office. If you drive home yourself, keep the legs moving and make frequent stops to walk (every 20 minutes). If the legs become painful after the injection, walk some more.
2. Maintain normal daytime activities; walk at least 20 minutes a day - the more the better. Avoid strenuous physical activity (e.g., high impact aerobics, jogging) for the first 48 hours. Thereafter you can resume all of your normal activities.
3. Do not remove the stockings or dressings until the next morning. The compression stocking should then be worn for an additional five to seven days but may be removed overnight while sleeping.
4. No hot baths for one week (warm showers are OK). Avoid prolonged standing. If you must stay in one place, move your legs frequently.
SUMMARY
Injection sclerotherapy is an effective, safe and relatively inexpensive office treatment for spider veins, can be done with very little discomfort, and with minimal interruption of your day-to-day activities. As many or as few veins as you wish can be injected. No extra time off needs to be taken from work. If you would like to speak with someone who has had these treatments, you may call the office and we will provide you with the names and phone numbers of individuals who have graciously consented to discuss their own treatment and results.