Vein Treatment (cont.)
Spider Veins
What are spider veins?
Spider veins are tiny, dilated blood vessels seen in the skin usually on the face and legs. These veins are located just below the surface of the skin and due to their location, often appear darker and more prominent-being red, blue, or purple in color. Although spider veins may result in itching and minor aches and pains, they are not a health hazard. They are mostly a cosmetic problem.
What causes spider veins?
Spider veins are formed when veins become dilated and swollen with stagnant blood. Pregnancy and hormonal variations as well as hereditary factors may stimulate their appearance. Spider veins are more common in women.
How are spider veins treated?
Sclerotherapy remains the treatment of choice for the treatment of spider veins although we offer laser treatment in our office as an alternative. Sclerotherapy is the technique of injecting a specific solution called a "sclerosing agent" into the spider veins with a very tiny needle. The discomfort is minimal and no worse than a bug bite with mild stinging. The solution irritates and destroys the inner lining of the blood vessel, so it ceases to carry blood. The body then replaces this damaged vessel with imperceptible scar tissue under the skin which is not visible. This does not harm the circulation but actually improves it by eliminating the abnormal, unnecessary vessel. Several injection sessions may be needed to improve a specific area. Treatment sessions usually last 15-30 minutes.
How long does it take to look better?
The tiniest spider veins may disappear in several weeks. Following treatment, the veins may look darker in color with some bruising. Some blood may become trapped in the veins as they close down- this is expected and is addressed during your subsequent treatment sessions. The larger veins may require several months to improve in appearance. A level of 70-90% overall improvement is realistic. Normal healing can take approximately 8 weeks.
What are the side effects of sclerotherapy?
The most common side effects experienced with sclerotherapy include itching, discoloration of the skin overlying the veins, pain, telangiectatic matting (blush areas), ankle swelling, phlebitis (inflammation of the veins) and rarely, allergic reaction. Rare complications consist of ulceration of the skin which could produce a small scar. Patients are advised to wear surgical support hose following their treatments to reduce side effects.
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Varicose Veins
Ambulatory Phlebectomy
Not all veins can be treated with sclerotherapy. Some varicose veins are too large and either will not close with sclerotherapy or will re-open. In the past, these veins were treated by stripping and ligation. This procedure was done in the hospital under general anesthesia and required a period of rest and had a poor cosmetic result due to the large incisions.
Ambulatory Phlebectomy, developed in Europe and now performed in many areas of the United States -including our office- is a minimally invasive procedure performed through pinhole incisions. This technique permits removal of almost all larger varicose veins as an office procedure performed under local anesthesia. It is often used in conjunction with sclerotherapy to reduce the pressure in the smaller telangectastias and spider veins resulting in a more efficient sclerotherapy.
This procedure is part of a complete program used to eliminate unsightly or painful leg veins. Using a combination of sclerotherapy and ambulatory phlebectomy, almost all varicose veins of the leg can be successfully treated in the office with an excellent cosmetic result and little to no "down time".
The Procedure
Prior to surgery, the degree of reflux (backward flow) in the incompetent veins is evaluated and the location of the veins is determined by Doppler ultrasound, which picks up the sound of blood flowing the wrong way. Also used is a Venoscope, which can localize deeper vessels as well as by visualization or palpation. The vessels are marked with a surgical marker.
The procedure is performed in our office. It is done under local tumescent anesthesia, which is relatively painless. The patient is comfortable throughout the procedure. Small pin hole incisions are made adjacent to the varicose veins and the veins are removed. There is almost no bleeding and the incisions heal without stitches.
After all of the veins are removed, the leg is wrapped with an elastic bandage. Patients are able to walk immediately. When the elastic bandages are removed, surgical support hose are worn daily for three days. Patients may stand, walk, and return to work on the day following the procedure. Strenuous activity is restricted for two weeks. The results of the procedure have been excellent both from a cosmetic and patient satisfaction point of view.
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