The most cost-effective treatment for the majority of spider veins is conventional sclerotherapy. This treats both the reticular feeder and spider veins together. Sclerotherapy is the injection of small amounts of a special solution directly into unwanted veins. If you’re considering sclerotherapy make sure you have all the facts and feel 100% comfortable about your decision. Dr. Kanter has provided his Seven Steps to Successful Sclerotherapy guide to make sure you make the right decision for you!
- CONSULTATION: Vein disease is in fact a medical problem, and we treat it as such. We therefore allow time for the attention to detail necessary to make an accurate diagnosis, and to answer any questions you may have before you leave the office. After a careful review of your medical history and concerns, every patient with leg veins receives a painless Doppler screening examination to determine if there are deeper veins feeding the surface veins.
- EXPERTISE: In expert hands, success rates are close to 90%. Like other technical procedures, more practice leads to improved results with less complications. Most of the time, nearby subtle, flat, blue-green (“reticular”) veins are the source of spider veins and should therefore be treated simultaneously. Many doctors performing sclerotherapy as a sideline either ignore or avoid treating these feeder leg veins.
- SOLUTION: In the United States there are three commonly used sclerosing agents: sodium tetradecyl sulphate (STS), aethoxysklerol (ATX), and hypertonic saline (HS). Phlebologists prefer either STS or ATX because they cause minimal discomfort on injection and can be used to treat veins of all sizes. STS was FDA approved in 1946, and has a long track record of safety and effectiveness. Although originally used full strength for large varicose veins, it is also used in diluted concentrations to treat spider veins. It is therefore, heavily favored by phlebologists due to patient comfort, versatility, and safety. In my office (Vein Center of Orange County or VCOC) I have primarily used STS since 1990 with excellent results, and have more recently added ATX as an alternative agent when appropriate. Because we use very small needles (30g), and because the solution we use does not cause intense burning like hypertonic saline, there is only minor discomfort. Accordingly, no anesthesia is required.
- COMPRESSION: Compression stockings help to prevent blood clots by facilitating venous blood return back to the heart, thus decreasing pooling and stagnation. They also decrease the volume of trapped blood in successfully closed veins by preventing refilling, thereby decreasing the usual tenderness, lumpiness, and discoloration of treated veins.
- WALKING: The simple act of walking does amazing things for your circulation. With each step, calf and foot muscles contract forcing blood into deeper leg veins transporting it back up to the heart. Thus, walking reduces complications and discomfort by improving blood flow in the leg, thereby enhancing treatment results.
- AEROBIC ACTIVITY RESTRICTED: After sclerotherapy for leg veins, one must avoid vigorous aerobic activities for several days in order to allow the treated veins time to heal. Aerobic activities increase blood flow to the lower extremities with force thus causing the recently treated veins to reopen, thereby reducing treatment results.
- BE PATIENT: Once veins are treated they will collapse, shrink, and later be absorbed. Temporary bruising occurs to some extent with every patient, and usually fades within 1-2 weeks following treatment. Hyperpigmentation appears as brownish streaks or spots often mistaken for bruising. This occurs at the site of more prominent veins and will eventually disappear over time. The successfully closed veins from sclerotherapy contain blood, and blood contains iron. As the vein shrinks, iron is released into the skin where it causes a brown discoloration; this is called “post-treatment hyperpigmentation.” The iron is slowly removed by the body’s natural scavenging system (the reticuloendothelial system) for recycling into new blood cells. People vary greatly in the efficiency of this “mopping up” operation. This causes some people to have very little discoloration that disappears quickly in a few weeks, while others have darker discoloration that takes months to disappear; overall average is 4-8 weeks.