Spider Vein Treatment

What are Spider Veins?

Spider Veins are the small thin, thread-like veins that are seen just beneath the surface of the skin.  These are very small blood vessels that appear on the face and legs.  They sometimes look like spider webs or tree branches. It is very common to find spider veins on the lateral thigh.  Spider veins are caused mainly by heredity.  Other factors contributing to spider veins includes weight gain, long periods of standing, and increased hormones during pregnancy.  Its been estimated that fifty percent of women in the United States are affected by spider veins and up to 80 million Americans cover their legs daily because of unsightly spider veins.  Some patients seek medical treatment for spider veins because they are uncomfortable with symptoms, such as aching, burning, swelling and cramping.  Properly treating these veins corrects both your symptoms and the appearance of your legs.

The gold standard for treating spider veins and smaller veins is sclerotherapy.  A sclerosing solution is injected into the vein, which causes the vein to collapse. The vein is gradually absorbed by the body.  There are several new sclerosants that are much more effective, safer, and less painful than hypertonic saline or salt solutions.  It is very important to treat the feeder veins which are causing the spider veins.  We use special lights to look for these very important feeder veins.  If the source is not treated the veins will return.  This is another reason external lasers or transdermal lasers are not very effective.  Lasers are not effective as precise injections into the veins, and they cannot destroy the source of the spider veins.  If your doctor only offers laser treatments,  be prepared for less than optimal results. Sclerotherapy done poorly or with an ineffective sclerosant, such as saline, does have a high recurrance rate.  So it is important to see a doctor who has specialized training  in phlebology. Be sure your doctor has special light sources to transilluminate the skin, and look under the skin to find the feeder veins.  Ultrasound is also important even with simple spider veins, ultrasound helps eliminate all sources of reflux which may be causing the spider veins.

Who should do the treatments for spider veins?

Have your veins treated only at a practice that specializes in phlebology.  The doctor or nurse should be board certified or specially trained in phlebology.  You should not allow non-physician treatment unless the doctor is on the premises or the provider is a nurse practitioner with special training.  Seek out a center where the practice is dedicated to the treatment of venous disease.

Dr. J. Michael Leary at California Vein Specialists is a specialist in venous disease.  He is board certified in phlebology and emergency medicine.  He has specialized exclusively in venous disease for over nine years.  Dr. Leary is a recognized leader in endovenous procedures, training many physicians from all over the United States.

Sclerotherapy is an extremely safe and effective procedure when performed properly.  As with any medical procedures complications can occur. I will review the most common and rare complications.

1) Localized urticaria are small raised hive like bumps that may appear at the injection site, they may feel itchy and may appear red.  They will usually resolve in a few minutes.   Usually patients don’t notice them as soon as they put stockings on.

2) Hyper pigmentation is a brownish discoloration that occurs over the treated vein.  It usually appears a few weeks after treatment.  Hyper pigmentation is due to a hemosiderin (iron) deposition in the skin. Most staining clears gradually in about six months.  Sometimes it will last up to a year and rarely over a year.  Hypertonic saline causes more staining and if a sclerosant is too strong there is more risk of staining.  Sometimes if areas of reflux are not treated (feeding veins) staining can occur.  Certain people with high iron stores are more prone to staining and patients with more pigment in their skin tend to be more prone to staining.  Also patients who are on Minocycline tend to stain.  It is important to drain any trapped blood in treated veins, as the blood is the source of iron.  Treatment for staining is usually tincture of time.   IPL and some laser treatments may speed up the resolution.  Bleaching agents are usually of no help.

3) Matting is an area of blushing or redness that can appear after sclerotherapy.  Matting is made up of very small red telangiectasias or tiny red vessels.  The cause of matting is unknown.  Factors such as obesity or a family history of matting, excess estrogens may predispose to matting.   Sometimes a vein that has not been completely closed may cause matting.  Too strong of a sclerosant, such as hypertonic saline may cause matting and using too much pressure when injecting may cause matting.  Most matting will resolve on its own but at times can remain permanent.   When matting occurs meticulous search for a cause should be sought, this includes ultrasound exam and transillumination to find small feeding veins that may have been missed.  Laser may also work to remove matting.

 4) Cutaneous ulceration is a very rare complication of sclerotherapy.   It is occurs with the use of hypertonic saline most commonly.  Hypertonic saline is a sclerosant that we feel should not be used.  It is not very effective and has numerous drawbacks.  Ulceration can occur with other sclerosants but is very rare.  If a small ulcer develops, they are usually small and will heal within a few weeks.  Ulcers can leave dark shallow scars.

5) Deep venous thrombosis is a very rare complication of sclerotherapy.  Studies have shown that the incidence of DVT is less than the incidence that occurs in the untreated general population.  Important steps to avoid DVTs after sclerotherapy include wearing compression hose and being active.

6) Allergic reactions are very rare complications of sclerotherapy, but can occur with the use of any sclerosant. 

 The most common complications of sclerotherapy are fairly common and often self-limiting.