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Sclerotherapy

Spider veins are small, superficial blood vessels that appear red, blue or purple. They commonly occur on the legs, but frequently occur on the face or elsewhere.

These tiny dilated blood vessels may occur as isolated strands, each about the size of a large hair or diffusely connected in massive unattractive sunburst patterns. They may also look like a spider web or tree with branches. Typically, spider veins reside within the layers of the skin (intradermal). Larger veins situated just beneath the skin frequently communicate with the intradermal spider veins.

Patients can be quite symptomatic from these tiny vessels, ranging from a dull throbbing pain, to a burning or itching sensation. The larger varicose veins are more likely to cause aching, heaviness, throbbing, cramping, and occasionally be quite tender to the touch.

If spider veins are unsightly, or uncomfortable, they can be treated with injection therapy which will cause them to disappear or become a much smaller in area and size. Overall improvement following a series of sclerotherapy injections range between 50 and 90%.

What causes these tiny intradermal vessels to become visible?

The cause of spider veins is not completely understood. In many cases they seem to run in families. Identical twins are often affected in the same area of the body and to the same extent. The condition rarely occurs as part of a systemic disease.

Spider veins appear in both men and women, but more frequently in women. Female hormones, progesterone, or hormonal replacement therapy seems to bring them out. They may also appear after injury, as a result of wearing tight girdles or from hosiery held up with tight garter belts. Spider veins are commonly seen with large varicose veins.

Spider veins probably can’t be prevented. Wearing support hose may minimize these unwanted blood vessel from developing. Keeping one’s weight at a normal level and exercising regularly may also be helpful. Eating a high fiber diet and wearing low heeled shoes may also help. Sun protection is extremely important to limit the number of unwanted vessels on the face.

How are unwanted blood vessels on the legs treated?

The injection method also called sclerotherapy is used to treat unwanted blood vessels. The sclerosing solution,is injected with a very fine needle, directly into the blood vessel. This procedure has been used for spider veins since the 1930s and before that, as treatment for varicose veins. The sclerosing solution irritates and damages the inner lining of the vessel wall causing it to swell, and the walls to stick together. Over a period of weeks the vessel turns into scar tissue that is absorbed, eventually become barely noticeable or invisible.

Spider veins and small varicose veins may have to be injected more than once to achieve the desired result. The sessions are spaced at four to six week intervals. A good rule of thumb is to expect a 50 to 60% improvement after each session. Each session lasts for 30-45 minutes.

Frequently, larger varicose veins and smaller subdermal reticular veins communicate or feed into the spider veins. In these the cases, the feeder vein should be treated before the spider veins. If a feeder systems is large, microsurgical excision and/or radiofrequency Venefit Closure is performed first.

The Modesto Vein Center uses Asclera or STS (sodium tetradecyl sulfate), both FDA approved as sclerosing agents.

Are there side effects to sclerotherapy?

Even with a highly experienced physician or sclerotherapy technician performing the treatment there are possible side effects. They include:

  • Stinging or pain at the sites of injection. Hypertonic saline, which we never use, is most frequently associated with the burning after sclerotherapy. Asclera seems to produce the least the symptoms and is our preferred agent. There is minimal discomfort with this solution.
  • Red and raised areas (wheals) at the injection sites. This phenomenon is a common occurrence and is much like a mosquito bite. Mild itching also may occur. This resolves within two hours.
  • Brownish pigmentation lines or spots may occur at the sites of treated spider veins. The brownish pigmentation results from the breakdown products of red blood cells and hemoglobin. It occurs approximately 20 to 30% of the time. Resolution sometimes takes several months.
  • Small ulcer formation may occur following sclerotherapy. This occurs approximately .5% of the time. Resolution always occurs but may take several months.
  • Matting or the development of groups of fine tiny red blood vessels near the injection sites may occur. These usually resolve spontaneously but may take several months.
  • Allergic reactions to the sclerosing solutions are extremely rare.
  • Vein Inflammation: small varicose veins, often trap blood following sclerotherapy. Mild tenderness and lumps may be present. This represents a postinjection inflammation of the vein wall with a tiny bolus of blood . This is best treated by needle drainage. Doing so reduces the chances for brownish pigmentation and relieves inflammatory discomfort.

Will treated veins recur?

Spider veins and varicose veins may return after therapy. The sclerosed veins, thermally and surgically ablated veins, do not recur. They have been removed from the circulation.

Recurrent varicose veins after therapy represent the development of new abnormal veins. Remember, varicose veins and spider veins are not curable, but they are controllable.

The Modesto Vein Center takes great care in reducing the trauma to the skin when removing abnormal veins. When former patients who have had large and severe varicosities removed return with new veins, years later, it is often impossible to find any trace of prior treatment.

How are spider veins on the face treated?

There are several ways to treat spider veins on the face. The Modesto Vein Center utilizes the Veinwave. This system utilizes pulsed radiofrequency energy to eradicate the tiny red veins of the face. It is also very effective in removing tiny cherry red spots on the trunk, legs and arms.