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 the 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 telangiectasias
are best treated by vascular laser initially. Blue vessels, especially
on the legs, are best treated with a Yag laser if injection therapy
is not appropriate. Facial telangiectasias (fine, red superficial
vessels)
are best treated with vascular laser versus injection sclerotherapy,
as injections into facial vessels are dangerous. Injection therapy
and Yag laser treatment for lower extremity spider veins are complementary
procedures whose application must be individualized to clinical
circumastances 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 TREATMENT
The postoperative instructions should include elevation of the
lower extremities as much as possible 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.
Support hose (compression
stockings) are recommended, but not required for laser treatment
of leg vessels. They can be used for comfort and to control
swelling for 7-14
days after treatment as needed for leg treatments.
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 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.
Neodynium:
YAG Laser – For Treatment of Blood Vessels
Patient Information Sheet
The following information will help you to understand how the Neodynium:YAG
Laser is used to clear your vascular lesions.
How does the Neodynium:YAG Laser work?
The Neodynium:YAG Laser produces an intense burst of invisible laser
light that selectively destroys fine superficial blood vessels without
damaging
the surrounding tissue. After laser treatment, the skin overlying
the treated area remains intact. The blood vessels clot due to the
effect of the laser
light energy. They gradually diminish in visibility over several
months.
The Neodynium:YAG Laser, at a wavelength of 1064 nanometers, targets
blood vessels as deep as 3mm in the skin. It is reliable, safe
and comfortable
due to its cooling device. The operator can control the delivery
of laser energy very precisely.
For vascular lesions, 3-4 treatment sessions 8 weeks apart is
needed to achieve maximum improvement. The final result is not
expected,
and cannot
be judged, for 3-4 months following the last treatment. This
time line is dictated by the gradual healing of the skin due
to new collagen
formation,
and the obliteration of small blood vessels in the treated areas.
Are there other ways to treat my vascular lesion?
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. 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 YAG laser therapy.
Some types of leg telangiectasias are best treated by YAG laser
initially. Blue vessels, especially on the legs, are best
treated with a Yag
laser if injection therapy is not appropriate. Facial telangiectasias
(fine,
red superficial vessels) are best treated with vascular laser
therapy versus injection sclerotherapy, as injections into
facial vessels
are dangerous.
Injection therapy and Yag laser treatment for lower extremity
spider veins are complementary procedures whose application
must be individualized
to
clinical circumstances and desires.
For other types of vascular lesions, such as port wine stain
birthmarks, stretch marks, scars, facial spider veins or
warts, some patients
have tried surgery, electrocautery, cryotherapy (freezing
the area) or tattooing.
These procedures may result in scarring or may leave an
unsatisfactory result.
Other lasers such as the Ruby Laser, Argon Laser and CO2
Laser have also been used to treat vascular lesions.
These lasers
are not as
specific to
the destruction of the blood vessels in vascular lesions
and have resulted in scarring in many individuals. Because
of the
chance of
scarring, the
use of these lasers in infants and young children is
not recommended.
If you have been treated by other modalities which resulted
in scarring or loss of pigment, the lesion may not
respond as well
with the laser
therapy. The scarring or loss of pigment may become
more evident after treatment
with the laser.
The depth of penetration of the YAG Laser is limited
to vessels about 3mm in depth. Therefore, vessels deeper
than
this may
not respond
to the therapy.
What should I expect from this laser treatment?
Treatment with the YAG Laser will consist of multiple
(3-4) treatments for best results. These treatments
occur on
an average of every
8 weeks. Individual situations may vary and it is
best to discuss yours
with Dr.
Kuisle, Dr. Hartley, or your IV Seasons Skin Care
aesthetician.
The type of vascular lesion to be treated will determine
the number of treatments needed.
For some areas, a topical cream anesthetic or local
injection can be used if requested. The cooling
device included
with the YAG Laser
treatment
automatically cools and numbs the skin prior
to the laser light burst. The feeling of a laser pulse
has
been described
as that
of being
snapped by a rubber band or a slight stinging
sensation. Following laser treatment,
the area may continue to sting slightly or feel
warm like a sunburn for a few hours or days.
If a larger area is to be treated, anesthesia
may be used. A small test area can be performed
before
the
entire area
is treated
to evaluate
your
pain tolerance. Most patients tolerate this
procedure without any need for anesthesia. Applying ice
packs to treated
areas can alleviate
any discomfort
experienced following the procedure.
The duration of your laser treatment depends
on the size of the area you will have treated
or the
time
allotted
by Dr.
Kuisle,
Dr. Hartley,
or their
designated operator to perform your treatment.
The usual treatment session lasts 15-30 minutes,
and
may be repeated
at a minimum
of 8 week intervals.
Are
there any adverse effects?
With any laser therapy there is a possibility
for adverse effects. The following are adverse
effects
that may
occur with the YAG
Laser:
1. The treated area may hyperpigment, or
appear darker after the bruising/red discoloration
heals. Normal
skin color usually
returns
within 6 months
after laser therapy.
2. Scarring is a risk with the use of any
laser. If the post treatment skin care instructions
are not followed,
this can
increase the chance
of scarring.
3. The treated areas may show a slight depression
after the laser treatments. This depression
usually resolves
within
a few months.
Preoperative Instructions
for Vein Therapy
Post Treatment Instructions
for Vein Therapy
Vein Therapy Consent
Form
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