MCQ:

Drug used for sclerotherapy of varicose veins -
a) Tetracycline
b) Ethanolamine
c) sclerosant


Spider veins are also known as broken capillaries. These are nothing more then tiny blood vessels no more than 2 mm in diameter that may appear on different places on the body such as face, legs and ankles. They are very easy to recognize because they are bluish, purple or red and often form a web-like netting just below the skin’s surface. Spider veins are generally just an unattractive nuisance, although when they become large they can cause heaviness in the legs, night cramps and itching.

Varicose veins are a similar condition, although they represent the veins near the surface of the skin on the legs which have become permanently distended and filled with blood. The heart pumps blood to supply oxygen and nutrients to all parts of the body. Arteries carry blood from the heart towards the body parts, while veins carry blood from the body parts back to the heart. Veins have valves that are designed to prevent blood from flowing backwards due to gravity. When a valve malfunctions or vein walls weaken, blood collects in the vein, causing it to bulge.


Sclerotherapy for varicose veins



Causes of spider veins

A number of factors contribute to the development of spider veins, including:

• heredity
• pregnancy
• hormonal shifts
• lack of exercise
• obesity
• weight gain
• occupations or activities that require prolonged sitting or standing
• use of certain medications

Spider veins appear in both men and women, but are more frequent in women. The fact is also that female hormones may play a role in their development. That’s why puberty, birth control pills, pregnancy, or hormone replacement therapy may contribute to their forming. They may also appear after an injury or as a result of wearing tight girdles held up with elastic bands. Varicose veins are mainly caused by the genetic susceptibility.



Treatment of spider and varicose veins – SCLEROTHERAPY

Spider vein removal or sclerotherapy, is a procedure designed to permanently remove the spider veins, making the legs look younger and healthier. This involves either delivering intense pulsed light to the veins, or injecting a sclerosing solution that collapses the veins and causes them to fade away. Sclerotherapy as an injection therapy is a special, non-surgical, procedure in which a solution is injected into the varicose veins or spider veins in order to cause their disappearance. A variety of solutions are used in sclerotherapy and the dosage is usually adjusted based on the size of the veins. The good thing about this- non-surgical incisions are made and anesthesia is not necessary. When a problem vein is closed off via sclerotherapy, the blood will re-route through normal veins and flow much more efficiently.


Benefits of sclerotherapy

There are many reasons why a person would want to have a spider vein removal.

The most common reasons are:

• Enhancing appearance and self-confidence
• Improving the appearance of the skin
• Wanting the legs to look younger
• Removing bothersome symptoms associated with spider veins



Ultrasound guided sclerotherapy

Ultrasound guided sclerotherapy is a special method that uses ultrasound to locate the underlying leaking veins! The leakage could come from small 'perforated veins' that are usually below the knees, behind the knees or in the groin.

Indications for this type of sclerotherapy are:

• Very large varicose veins
• Leg ulcers
• Skin conditions

Laser therapy

Lasers have been used in varicose vein therapy for more than twenty years, but patients are still often suspicious about it. Wavelengths of light are absorbed by the hemoglobin in the blood vessels to destroy them. Many types of lasers are being used such as pulsed dye, long-pulsed, variable-pulsed Nd-YAG, and Alexandrite, as well as the non-laser intense pulsed light technique.


Expectations

Complete correction is not expected after the first treatment. Only about 50 to 70% of the treated vessels will be permanently gone. 3 to 4 treatments are generally required for optimal results.


Possible procedure complications

Possible side effects of sclerotherapy include:

This can be due to a number of reasons including lack of compression, inadequate compression, hormonal supplements, vitamin E supplements, use of anti-bruising creams or creams containing vitamin E, and inadequate treatment of underlying veins. Matting may resolve spontaneously but it may last for a year or longer. It can also be treated using special injection techniques.

• Ulcers may form at the site of the injection. They can occur immediately after the injection or a few days later. They are rare, but can be quite painful and usually leave scars after they heal.

• Inflammation and blood clots can affect the treated large veins.


Prevention of spider and varicose veins

There are several simple things you can do to help prevent varicose and spider veins and to relieve the discomfort from the ones you have:

• Protect your skin from the sun by wearing sunscreen to prevent spider veins on the face.
• Exercise regularly to improve your leg strength, circulation, and vein strength.
• Control your weight to avoid placing too much pressure on your legs.
• Do not cross your legs when sitting.
• Do not stand for long periods of time.
• Wear elastic support stockings, but avoid clothing that is too tight or that will constrict too much


Alternative therapies

Some dermatologist are recommending a classical surgical approach to this problem, although it has been used less and less in the last couple of years! Some physicians bandage the injected areas and instruct patients to compress the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin, and reduce the development of dark spots. Others put tape dressings on the areas and do not use compression unless the veins are large or in special locations.


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It is estimated that almost three-quarters of all adult women have spider veins – red, blue or purple thread-like lines just under the skin. The condition is associated with increased pressure to the veins.Spider veins are caused by abnormal blood flow and weakening of the blood vessel wall in the affected veins. Any condition or activity that puts pressure on the veins -- such as gaining weight, and sitting or standing for long periods of time -- can contribute to their development.Although treatment does not prevent the development of new spider veins, the removal of existing veins can dramatically improve the appearance of the affected area, providing a more youthful, healthy look and an even color pattern to the skin. Veins lighten after each treatment. Two or more sessions are usually required for the best results.
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Varicose Vein Treatment and Removal