Sclerotherapy : Spider Vein Treatment
Sclerotherapy: Spider Vein Treatment
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
Sclerotherapy uses an injection of a special chemical (sclerosant) into a varicose vein to damage and scar the inside lining of the vein. This causes the vein to close.
During this procedure, the affected leg is elevated to drain blood, and the sclerosant is injected into the varicose vein. The procedure is done in a doctor's office or clinic and takes 5 to 30 minutes, depending on how many varicose veins are treated and how big they are.
After the injection of sclerosant is given, pressure is applied over the veins to prevent blood return when you stand up. You may need to wear compression stockings or elastic bandages for several days or weeks to maintain the pressure.
The sclerotherapy injection may be painful, and the chemical (sclerosant) that is injected can cause a feeling of burning or cramping for a few minutes in the area where the shot was given. You may need repeated sessions and many injections each session, depending on the extent of the varicose veins and type of sclerosant used.
A newer technique allows your doctor to inject sclerosant with a catheter. The catheter and sclerosant are guided to the affected vein with the help of duplex ultrasound. This process allows sclerotherapy treatment to be used on larger varicose veins that previously could only be treated surgically with ligation and stripping, in which larger varicose veins are tied off and removed. Sclerotherapy is probably safer and more effective using duplex ultrasound–guided catheter injection, because it allows easy and precise access to veins.
In addition, early studies show that when used with duplex ultrasound guidance, foam sclerosant has some advantages over liquid sclerosant. Foam sclerosant may be safer, more effective, and lower in cost than conventional liquid sclerosant. 2 3 Foam for treating large veins is not yet widely available in the United States.
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.
Symptoms
Spider veins usually take one of three basic patterns.
• Spider shaped
They may appear in a true spider shape with a group of veins radiating outward from a dark central point.
• Branch-like shaped
They may be arborizing and resembling tiny branch-like shapes.
• Linear shaped
They may appear as thin separate lines. Linear spider veins are commonly seen on the inner knee, whereas the arborizing pattern often appears on the outer thigh in a sunburst or cartwheel distribution.
Although many people think that these two things are the same, varicose veins differ from spider veins in a number of ways. Varicose veins are larger, usually more than a 6-7 milimetres in diameter, darker in color and tend to bulge. Varicose veins are also more likely to cause pain and be related to more serious vein disorders, while the spider veins are painless.
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
Indications for the therapy
The statistical fact is that most women who undergo treatment are usually between the ages of 30 and 60. Men can also receive this treatment, but it is such a big cosmetic problem because body hair usually conceals the spider veins. The ideal candidate for the spider vein removal would be a patient who would like to improve the appearance of the legs. A person considering this procedure should have realistic goals and expectations.
Pregnant or breastfeeding women should consider holding off on treatments for spider veins through injection sclerotherapy. That’s because spider veins caused by pregnancy will disappear on their own a few months after the baby is born.
Ultrasound guided sclerotherapyThe procedure
• Laser Light Therapy
If there are several affected veins, the larger veins are usually treated first. During this procedure, a dosage of intense laser light energy is delivered to each vein in a series of long or short pulses. The blood vessels then absorb the light energy, which causes the blood within the vein to coagulate and close down the vein.
• Injection Sclerotherapy
Each treatment session lasts about 15 to 45 minutes depending on the condition of the veins. While stretching the skin to keep it tight, the doctor is injecting the sclerosing agent into the spider veins. This is usually performed with the help of some magnification tool. The spider vein removal involves many injections, one for every inch of spider vein. During the treatment five to fourty injections may be given.
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.• Bruising may appear at the site of the injection, but usually disappears in a few weeks.
• Brown lines or spots - These may appear on the skin at the site of the injected blood vessels and they usually occur when blood escapes from the treated vein into the skin. In most cases, this discoloration will disappear in time. Many experts are advising patients not to take iron supplements while receiving sclerotherapy, as brown lines are caused by the iron content of the red blood cells. Laser therapy can treat stubborn lines or spots, although this treatment cannot be guaranteed to work.
• Lumps may occur in larger injected veins but they are not dangerous at all. They will either be removed a few weeks after the injection or will clear on their own.
• Swelling may occur in people who have had large veins treated
• Matting - A network of fine blood vessels can develop after sclerotherapy.
• 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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