Spider Veins / Sclerotherapy

Spider veins or telangiectasias are small varicose veins located just beneath the skin. They are a problem for millions of people. You are not alone in your desire to rid yourself of these painful and unsightly veins. They may be inherited from your parents and may worsen with weight gain, pregnancy or simply for no identifiable reason.

In many cases, spider veins are of a cosmetic concern only. In other cases, they may in fact be related to an underlying medical problem known as venous insufficiency or reflux (backwards flow of blood in the veins). In either situation, symptoms associated with spider veins range from itching or a dull ache to throbbing pain and bleeding.

Sclerotherapy

Your physician will develop a treatment plan for your individual case. Spider veins can be successfully treated with injection sclerotherapy. Sclerotherapy is the most popular method of eliminating spider veins. This is the "gold standard" and is more effective and less expensive than lasers (for spider veins, not varicose veins). An FDA-approved medication called sotradecol is injected into the veins using very tiny needles.


This solution causes an irritation to the inner lining of the vein resulting in closure of the vein. The vein stops carrying blood and therefore disappears with time. The majority of people who have sclerotherapy performed have satisfying results and little discomfort.

Treatment differs from patient to patient, depending on the extent of the varicosities (size and number). An average of three to four treatments is required in most cases to achieve a 70%-80% clearing; 100% is not a realistic goal. The treatment sessions last approximately 15 minutes and are done at four to six week intervals to achieve optimal results.



   
Sclerotherapeutic Progress

     

After completion of the initial series of recommended treatments, successfully treated veins are either gone or are much less noticeable. However, patients with a history of spider veins tend to develop new ones (with or without treatment) and a yearly touch up may become necessary. If you have leaking valves in your deep veins, you will likely continue to develop spider veins if the underlying cause is not treated.

Sclerotherapy is a treatment for spider veins, not a cure.


Varicose Veins

Varicose veins are caused by damaged or diseased valves in your veins, which cause blood to flow backward in your legs, towards the sky, and away from your heart. This condition can also cause swelling and significant discomfort, especially at the end of the day. Compression stockings, exercise, weight loss, elevation, and salt restriction can reduce venous congestion and greatly improve your symptoms.

When pain persists, new non-surgical alternatives to vein stripping can permanently shrink the enlarged veins and reduce pain. Treatment options include placing a special catheter (laser or high-frequency ultrasound) into the enlarged veins. Smaller varicose veins, called spiker veins, can be treated by injecting a special medication into the veins (sclerotherapy). There are multiple treatment options, which should be carefully tailored to the individual patient.

Varicose veins are superficial veins that have enlarged due to increased pressure in your veins caused by incompetent, or leaking, valves that are much larger than spider veins. They are a problem for millions of adults. You are not alone in your desire to rid yourself of these unsightly and painful veins. You may have had them for years or they may have just recently become a problem for you.

Varicose veins may be inherited from your parents and may worsen with weight gain, pregnancy or may simply occur for no identifiable reason.

Varicose veins may cause an aching feeling in your legs or may result in pain, swelling, skin discoloration or even ulcers. They may be related to an underlying medical problem known as venous insufficiency or reflux (backwards blood flow in the veins). The disease is typically progressive and can eventually involve the entire saphenous vein (the vein that runs under your skin along your calf and thigh) as well as many of its branches if it is not treated.

Your insurance company will usually cover treatment of your varicose veins if they cause significant symptoms and if you have attempted conservative treatment for 3-6 months sometime in the past without relief (elevation, compression stockings, exercise and weight control).

The Cause: Incompetent faulty valves in your veins result in Reflux (downward, backwards blood flow in veins) and lead to varicose veins.

Veins in your legs are tubes that carry blood from your feet toward your heart. One-way valves are located inside your veins and should only allow blood to flow up, out of your legs and back to your heart. When valves go bad for different reasons, blood flows backwards and builds up or pools in your leg veins. The backwards flow of blood in your veins is known as reflux and places excess pressure on the vein walls. This causes veins to expand and become varicose and can result in leg swelling, permanent skin changes and non-healing ulcers as pressure is transferred to the skin.

In the case of varicose veins (big bulging rope-like veins visible on the skin), they are often related to leaking valves in the Saphenous Vein (the vein which is just under the skin and runs along the inside of your calf and thigh).

Should an ultrasound confirm reflux in the saphenous system, a procedure called endovenous laser ablation or Closure can be used to eliminate the underlying reflux by closing off the leaking vein which is the source of the problem.

Varicose Vein Handout


Venous Reflux

Venous insufficiency and reflux (backwards flow of blood in veins) occurs in nearly 50% of adults to some degree and many suffer from pain, swelling and varicose veins. Complications include permanent darkening of the skin, bleeding, phlebitis (clots) and formation of non-healing ulcers and infection.

Insurance companies have recognized saphenous reflux and painful varicose veins to be medically necessary if you have attempted conservative treatment for 3-6 months in the past:

  • compression stockings
  • exercise
  • weight control
  • elevation

Laser / Closure Procedure
(Endovenous Saphenous Vein Ablation)

Your physician will develop a treatment plan for your individual case. Varicose veins caused by reflux in the superficial saphenous vein can be successfully treated with endovenous ablation. Lasers and radiofrequency ablation (high energy ultrasound) have been used safely for many different medical applications throughout the body. In recent years, small fibers have been used successfully to deliver heat energy to treat varicose veins. These methods allow your doctor to close off the diseased superficial vein that contains leaking valves, thus preventing any further reflux (backwards flow of blood) into your varicose veins. 

The procedure is usually performed in the doctor’s office with numbing medicine and Valium, thus eliminating the need for hospitalization and general anesthesia. A laser catheter is placed into the diseased vein. Laser energy is delivered to close off the diseased vein. Recovery is quick. Patients are encouraged to return to normal activities the day after the procedure. The vast majority of patients have very satisfying results and little discomfort. 

 Once you have decided to proceed with endovenous laser therapy, you will be asked to come to the office to view a video on the procedure, discuss pre-procedure guidelines, discuss consent and sedation if desired, review financial issues with insurance and be measured for new stockings if you need them. This visit usually takes about 30 minutes and any further questions will be answered.

The following is a list of commonly asked questions related to varicose veins and their treatment:

What causes varicose veins?

Varicose veins occur for a number of reasons including age, prior pregnancy, weight gain, hereditary factors and prolonged periods of standing.

Is endovenous laser ablation effective?

Yes. Five year results in thousands of patients have demonstrated that this procedure is more effective than traditional vein stripping and successful in >90% of patients.

How does saphenous laser ablation work?

Thermal energy is delivered to the vein wall and this causes the leaking, diseased vein to close off so it does not continue to leak blood into the varicose veins.

Are patients satisfied?

More than 95% of patients have been satisfied in the short term as well as the long term.

Is this covered by insurance?

Most insurance companies cover endovenous laser procedures and phlebectomy if needed, the same as any other outpatient procedure (less your deductible) if you have pain and have attempted medical management (compression stockings, weight control and elevation) for 3-6 months sometime in the past.

Does this require hospitalization?

No, this is an office procedure and takes about 1 hour. You have the option for local anesthesia alone (lidocaine like at the dentist) or can have anesthesia if you are very anxious.

Are other treatments necessary?

You may still require sclerotherapy or tiny incisions to remove additional varicose veins after this procedure. We will also do an ultrasound several days after the procedure to check the status of the treated vein.

Does it hurt?

Some patients are more sensitive than others but few really complain of significant pain during or after the procedure. Patients typically describe an aching, burning or pulling sensation.

How long is the recovery period?

We encourage walking the same day and return to normal activities the next day. You should delay strenuous exercise for one week.

What is the difference between the laser procedure and radiofrequency ablation (CLOSURE procedure)?

Both procedures are FDA-approved, non-surgical methods of treating varicose veins. They are very similar in terms of how you are treated and what you will experience. The results for both procedures are excellent and this becomes a physician preference. The main difference is in the type of energy delivered by the catheter. One procedure is not proven better than the other.

Does loss of this vein cause problems with drainage of the leg?

No. An incompetent saphenous vein is essentially a non-functioning vein and blood that would have flowed through the vein has already been diverted into other healthy veins to drain the leg.

Why should I choose The Vein Center at Savannah Vascular and Cardiac Institute?

Unlike other vein doctors, our physicians are a unique group of all board-certified vascular specialists who are dedicated to comprehensive, non-surgical management of all vein problems. We have a very broad training from prestigious institutions around the world and have treated thousands of patients with venous disorders. The doctors and our staff will make you feel very comfortable and well cared for throughout your evaluation and treatment. If you do seek treatment elsewhere, make sure your physician has specific training as a Vascular Surgeon so you can be sure he has expertise in all aspects of the diagnosis and management of your circulation problems.



Abnormal Leg Veins: Simple Concepts and Satisfying Results
Minamally-Invasive Revolution in Vascular Surgery


www.phlebology.org

www.evlt.com