Vein treatments

What are spider (telangiectatic) and varicose veins?

Spider veins are formed by the dilation of a small group of blood vessels located close to the surface of the skin. Although they can appear anywhere on the body, spider veins are most commonly found on the face and legs. They usually pose no health hazard, but may produce a dull aching in the legs after prolonged standing and indicate more severe venous disease.

Varicose veins are abnormally swollen or enlarged blood vessels caused by a weakening in the vein's wall. They can be harmful to a patient's health because they may be associated with the development of one or more of the following conditions: phlebitis or inflamed, tender vein; thrombosis or a clot in the vein; and venous stasis ulcers or open sores from inadequate tissue oxygen and fluid retention.

Who develops spider and varicose veins?

The exact cause of spider and varicose veins is unknown, although heredity, pregnancy and hormonal influences are believed to be primary factors contributing to both conditions. More than 40 percent of women have some form of varicose conditions, with an increasing incidence of venous disease as one gets older, so that up to 80% of women have some form of venous disease by age 80. Slightly more women than men have varicose and telangiectatic leg veins.

What is sclerotherapy?

Sclerotherapy is considered the gold standard treatment for removing spider and some varicose leg veins. It is a very cost-effective procedure that seldom leaves a scar or produces adverse effects. It is typically performed on an outpatient basis by a dermatologic surgeon. A concentrated saline or specially developed chemical solution is injected with a very small needle into the spider or varicose vein. The solution causes the vein to close up or collapse and become scar tissue that is eventually absorbed by the body. The work of carrying the blood is shifted to other healthy blood vessels nearby.

Sclerotherapy generally requires multiple treatment sessions. One to three injections are usually required to effectively treat any vein. The same area should not be retreated for four to six weeks to allow for complete healing, although other areas may undergo treatment during this time. Many dermatologic surgeons have found that treating all abnormal veins in one session gives the best results.

Post-treatment therapy includes wearing bandages and support hose for two days to three weeks (most commonly one week) following treatment. Walking and moderate exercise also helps speed recovery. Although sclerotherapy works for existing spider and varicose veins, it does not prevent new ones from developing, but may decrease this risk.

Are there side effects or complications?

Most patients report few, if any minor side effects, which usually disappear in time. Temporary reactions can include a slight swelling of the leg or foot, minor bruising, pigmentation, the temporary appearance of new blood vessels, redness and mild soreness.

What are other treatments?

  • Laser surgery
    Laser and intense pulsed light (IPL) therapy may be effective for certain leg veins and facial blood vessels. The heat from the high-intensity laser or IPL beam selectively destroys the abnormal veins.
     
  • Electrodesiccation
    The veins are sealed off with the application of electrical current. The treatment may leave scars.
     
  • Surgical ligation, stripping and intravascular laser or radiofrequency ablation
    Certain varicose veins may require an in-hospital procedure, usually performed by a vascular surgeon, which involves making an incision in the skin and either tying off or removing the damaged blood vessel. This procedure has been mostly replaced by intravascular laser or radiofrequency ablation of varicose veins. Intravascular laser or radiofrequency ablation, pioneered by dermatologic surgeons, is performed entirely under local anesthesia. A laser fiber or radiofrequency catheter is inserted into the abnormal vein which is then sealed closed by thermal energy. Patients are awake during the procedure and can resume almost all normal activities immediately after the procedure.
     
  • Ambulatory phlebectomy
    Removal of undesired veins through a series of tiny incisions along the path of an enlarged vein. This procedure, pioneered by dermatologic surgeons is performed entirely under local anesthesia with patients being able to resume nearly all normal activities immediately after the procedure.  
     
  • Combined approaches
    Your dermatologic surgeon may utilize a combination of techniques and technologies to provide an optimal treatment program for your individual condition and lifestyle.