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Sclerotherapy

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Sclerotherapy Before and After Pictures
Before and After Photos courtesy of American Academy of Dermatology


If you suffer from problems related to varicose and spider veins, you are not alone. It is estimated that more than 80 million Americans suffer from some form of venous disorder.
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While some people seek treatment for cosmetic improvement, many seek relief from pain. Help is available.

What Are Varicose Veins?

Veins and arteries, while both part of the circulatory system, function quite differently from each other. "Poor circulation" is a nonspecific term which often refers to arterial blockages. Arteries bring oxygen-rich blood from the heart to the extremities and can be thought of like a tube or hose. Veins, unlike arteries, have one-way valves and channel oxygen-depleted blood back toward the heart. If the valves of the veins don't function well, blood doesn't flow efficiently. The veins become enlarged because they are congested with blood. These enlarged veins are commonly called spider veins or varicose veins. Spider veins are small red, blue or purple veins on the surface of the skin. Varicose veins are larger distended veins that are located somewhat deeper than spider veins.

Pain in the legs is frequently related to abnormal leg veins. Symptoms, often made worse by prolonged standing, include feelings of fatigue, heaviness, aching, burning, throbbing, itching, cramping, and restlessness of the legs. Leg swelling can occur. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower leg.

Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, non-invasive ultrasound is often used.

What causes Varicose Veins

Heredity is the number one contributing factor causing varicose and spider veins. Women are more likely to suffer from abnormal leg veins. Up to 50% of American women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury.

When and how are veins treated?

The most commonly asked questions are: "Do veins require treatment?" and "What treatment is best?" Veins that are cosmetically unappealing or cause pain or other symptoms are prime candidates for treatment. There are two general treatment options: conservative measures, such as compression stockings, and corrective measures such as sclerotherapy, surgery and light source/laser treatment. In some cases, a combination of treatment methods works best.

Sclerotherapy

Sclerotherapy can be used to treat both varicose and spider veins. A tiny needle is used to inject the veins with a medication that irritates the lining of the vein. In response, the veins collapse and are reabsorbed. The surface veins are no longer visible. Sclerotherapy relieves symptoms due to varicose and spider veins in most patients. With this procedure, veins can be dealt with at an early stage, helping to prevent further complications.

You may need anywhere from one to several sclerotherapy sessions for any vein region. Depending on the type and number of veins being treated you may have one to many injections per session. Generally, normal activities can be resumed after sclerotherapy. Medically prescribed support hose and/or bandages may need to be worn for several days to several weeks to assist in resolution of the veins. The procedure, performed in the doctor's office, usually causes only minimal discomfort. Bruising and pigmentation may occur after sclerotherapy. Bruising typically disappears within 1-2 weeks. Although pigmentation almost always fades, it can last for several months. Scarring and other complications are rare.

How successful is sclerotherapy?

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.

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.

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.

Will treated veins recur?

Large veins may recur even after surgical procedures. Spider veins may also recur. It may seem that a previously injected vessel has recurred when, in fact, a new spider vein has appeared in the same area.

Is a history of blood clots in the lungs or legs a reason to avoid therapy?

Not necessarily, but the procedure must be done with caution to lessen the risk of blood clots.

Are there other treatment methods?

Ambulatory phlebectomy, developed by dermatologists, is a method using small punctures to remove varicose veins. The methods for larger varicose veins such as endovenous radiofrequency, and endovenous laser, may be used in combination.

What do I do after treatments?

Dermatologists may differ in their treatment instructions to patients. Most advise their patients to "clear" the sclerosing solution out of the circulation. Patients are instructed to walk following the procedure. Some physicians bandage the injected areas and instruct patients to "compress" the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin, and reduce the development of dark spots. It also may reduce the number of treatments necessary, and the possibility of recurrence. Others put tape dressings on the areas and do not use compression unless the veins are large or in special locations. Between treatments, many dermatologists recommend the use of compression or support hose. This may be recommended for people who spend a lot of time on their feet, or work in a standing occupation. The treatment of spider and varicose veins can be successful. Treatment methods vary depending on the size and location of the abnormal veins. The injection method is presently the method most commonly used, but great advances have been made recently in other techniques such as lasers.

For more information on Sclerotherapy or other cosmetic surgery procedures, please call us at Tel: (201) 227-1555.

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