Sclerotherapy - The injection method is a procedure called sclerotherapy. This procedure has been used for spider veins since the 1930's, and before that for larger veins. One of several kinds of solutions called sclerosing solution is injected directly into the blood vessel with a very fine needle. The solution irritates the lining of the vessel causing it to swell, stick together, and the blood to clot. Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable.
A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. A number of vessels can be injected in any one-treatment session.
The injection solutions available are slightly different, and the choice of which to use depends on several factors including the size of the vessel. Your dermatologist will choose a solution that is best for your particular case.
Occasionally, larger varicose veins are connected to them. In such cases, these vessels should be treated along with spider veins. This can be done by sclerotherapy, or the latest techniques using endovenous laser, stripping, ligation, or radiofrequency. Great advances have been made in the use of ultrasound to guide the injection of sclerosing solutions. Ultrasound may be used to treat large vessels, as well.
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.
There are some possible side effects with sclerotherapy, including:
• 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.
Laser Treatment - Lasers have been used for more than twenty years. Wavelengths of light are absorbed by the hemoglobin in the blood vessels to destroy them. Many types of lasers, pulsed dye, long-pulsed, variable-pulsed Nd-YAG, and Alexandrite may be used, as well as a non-laser intense pulsed light technique. Your dermatologist will recommend the best type of laser for you.
Other Treatments - 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.
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