SCLEROTHERAPY
(Vein Injections)
for TELANGECTASIAS (Spider Veins) of the LOWER EXTREMITIES
ABOUT THE PROCEDURE
Telangectasias are small blood vessels in the surface of the skin,
scattered throughout the lower legs, or other areas, which are less
than 1-2mm. in diameter.
Heredity, skin characteristics, activity (sedentary vs. ambulatory), pregnancy,
and physiologic fluctuations in hormonal levels all contribute to the visibility,
prominence and recurrence of the small vessels pre and post treatment. The primary
treatment for lower extremity spider veins consists of injection with a sclerosing
agent, which irritates the vessels and causes blood to clot within them. Subsequently
the body, with an inflammatory response, dissolves the clot and collapses the
vein with scarification of the vessel wall. The overall effectiveness of sclerotherapy
for surface telangectasias is about 60-70%. Some of these vessels recannulate
and recur over a period of several weeks to months. The whole process of obliteration
takes 3-4 months to complete its cycle. In general, there is improvement immediately
with less visibility of the vessels. Repeat procedures, when needed, can be undertaken
at 4-6 month intervals to address those vessels that have not completely responded
or new vessels. Injection therapy is to some degree self limited, in that residual
vessels become smaller and smaller in diameter and are unable to be cannulated
with even the smallest hypodermic needle. These types of vessels are best treated
with vascular laser therapy. Some types of leg telangectasias are best treated
by vascular laser initially. Blue vessels respond poorly to laser. Facial telangectasias
are best treated with vascular laser therapy versus injection sclerotherapy as
injections into facial vessels can be dangerous. Injection therapy and vascular
laser treatment for lower extremity spider veins are complementary procedures
whose application must be individualized to clinical circumstances and desires.
RISKS
Potential risks of this procedure include small areas of skin discoloration
or scabbing which may take several weeks to completely resolve. The
agents used
for sclerotherapy are fairly hypertonic and concentrated and can damage the skin
at the injection sites, especially if post operative instructions are not followed,
including elevation of the extremities and limitation of activities for the first
12 to 24 hours. There are also times when the minor bruising that is associated
with injection therapy can remain for longer periods of time. This has been noted
to occur for up to six months. If any significant residual scarring or areas
of pigment remain for long periods of time, the option for these would be subsequent
excision of the area and suture closure. This is rarely necessary.
POST OPERATIVE COURSE
The postoperative instructions should include elevation of the lower
extremities for the first 12 hours after injection therapy has been
completed. Elevation
can be lying in bed or raising the legs on a footstool or in a chair. It is also
important to utilize heavy support hose that are applied immediately after the
injection therapy session and should be worn for 4-5 days continuously. After
which they can be worn on an as needed basis for discomfort or swelling. Normal
daily activities can be resumed the day following treatment. Prolonged standing
or leg dependence should be avoided for 6 weeks following treatment, as this
will prolong the initial mild swelling that occurs following the injections,
but that should be mostly resolved by 10-14 days. Regular exercise can be resumed
as tolerated, usually within 4-5 days post treatment. Ibuprofen is beneficial
at dosages of 200-600 mg., 2 to 3 times a day for approximately 10 days to 2
weeks following the injection procedure. If evidence of infection, such as drainage,
redness, or unusual swelling occurs in the treated areas, then I would expect
you to immediately return to the office for evaluation.
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