The
“We treat people, not
just problems.”
John
L. Pfenninger, M.D.
(989) 631-4545
Visit our
website at: MPCenter.net
PATIENT EDUCATION HANDOUT
Spider veins are known medically as
"telangiectasias" and are small, dilated blood vessels. These may become unsightly with time and may also
lead to dull aching, itching, or stinging of the legs after prolonged
standing. Varicose veins are the large veins you see.
Sclerotherapy is the technique of injecting a
solution into these vessels using a small needle. The solution (we use a high concentration of
salt water) irritates and destroys the inner lining of the blood vessel so it
collapses and scars shut. This does not harm the circulation—it
improves it by eliminating the abnormal, unnecessary vessel. Several injections may be needed to totally
eliminate the vessels. The procedure is
virtually painless. Fading of the
vessels is a slow process that takes 1
to 6 months. The goal is to produce
a 75% to 90% improvement in both appearance and symptoms.
A consultation appointment is required
in advance of the injection visit. The
doctor will examine you and explain the procedure. Any testing that may be required is done, and
you will be custom measured for your support hose. We generally use Jobst, Sigvaris, or Medi
Charges relate to the amount of time spent
by the doctor. Actual injection is done
only by the doctor, rather than by a nurse or assistant. Because billing, reimbursement, and insurance
policies are complicated, for this procedure, please review the special billing information sheet carefully.
Results of treatment cannot be guaranteed, but most patients are very pleased
with the cosmetic and functional improvement.
Some commonly asked questions we
receive are the following:
1.
What causes spider veins?
No one is totally sure. Certain families are predisposed to this
condition, so it is partially genetic. Estrogens (female hormones), pregnancy, birth control
pills, tight girdles and garter belts, prolonged standing or sitting, and
trauma make spider and varicose veins worse.
2.
How does sclerotherapy work?
The solution destroys the tiny cells
which line the blood vessels, without damage to the surrounding tissues.
3.
How soon will the vessels disappear?
Each vessel usually requires one to
three treatments. The vessels disappear
over a period of 2 weeks to 3 months.
Recurrences may rarely occur over a period of 1 to 5 years. This treatment does not prevent new vessels
from developing.
4.
Are there certain vessels which tend
to recur more commonly?
Yes. They are the type of vessels which occur in a
mat of very fine radiating vessels. This
can occur on its own or may even come on after the injection itself. Large veins also may not respond well to
injections.
5.
How often can I be treated?
The same area should not be injected
for 3 to 4 weeks to allow for complete healing.
Different areas may be treated every week if necessary.
6. How many times do injections have to be
done?
This varies with the number of areas
that have to be injected, how numerous the veins are, their size, as well as
the response to each injection. It
usually takes one to three injections to obliterate any vessel; 10 to 40
vessels may be treated in any one session.
7. Are there certain kinds of spider veins
that can't be treated?
Certain types of large varicose
veins may not respond readily to sclerotherapy alone. These vessels may require a minor surgical
procedure to remove them with follow-up sclerotherapy for the smaller vessels
at a later time. You may be referred to a vascular surgeon for complete or
partial treatment of these specific types of large varicose veins. Some of the extremely small vessels (less
than 1/1000 of a millimeter) may require treatment with a Pulsed Dye Laser. Vessels on the face do better with different
treatments than sclerotherapy.
8. Are there other methods of treating these
vessels?
Three other
methods are used:
a.
Laser
surgery
To date, this method has only been
effective for tiny blood vessels. The
present laser systems tend to produce a greater risk of scarring. The laser is an expensive devise and
treatment is thus more costly.
b.
Electrodesiccation or cautery
This method produces a non-specific
destruction of both the vessel and overlying skin, thus resulting in a greater
incidence of scarring. It does work well
on the face but not the legs.
c.
Surgical ligation and stripping
This operative procedure is carried
out in an operating room. It is best
reserved for large varicose veins.
d.
There is a new method called “Photoderm”
treatment. It is expensive and not all
that
impressive. It does work for some.
9. Is there any way to prevent spider veins?
The use of support hose may be
helpful. Reducing your weight and
exercising regularly may also be of help.
10. What are
the side effects to injection treatments?
a.
Slight
stinging or burning may occur with
injection of certain types and concentrations of solutions in certain areas.
b.
Sometimes
a clot develops at the injection
site (especially if the recommended pressure stockings are not worn for the
proper amount of time or if large veins are injected). This clot will not generally cause internal
problems, but its removal within 2 weeks of the injection will speed the
healing process and decrease the incidence of discoloration. Removal is simple and only requires a minute
incision.
c.
Swelling over the injection site may rarely
occur. It is particularly common when
patients have jobs at which they stand for long periods of time or when vessels
in the ankles are injected. The swelling
is rarely dangerous but occasionally must be treated with elevation and
compression dressings.
d.
Superficial
thrombophlebitis, an irritation of
the injected vessel, occurs in less than 1 per 1000 patients. It may have to be treated with anti-inflammatory
agents and compression stockings.
e.
10%
to 30% of patients develop a small freckle-like tan to brown spot around the injected vessel. This usually resolves in 80% of these
patients within 3 to 6 months. A few
patients will have a persistent discoloration for up to a year.
f.
A
small superficial ulceration of the
skin overlying the injected vessel may occur.
This does not usually leave a scar but needs to be seen as soon as
possible by your doctor. It can take 6-8
weeks to heal.
g.
Sometimes
the body replaces the injected vessel with a “mat” of very fine vessels causing an apparent darkened area. This may need follow-up injections.
h.
The
injected sites will definitely look
worse for a few weeks before they look better!!
11. What
should I do before my appointment for treatment?
a.
Discontinue
aspirin and blood thinners 1 week prior to your appointment.
b.
Do
not shave your legs for 2 days prior
to your appointment. Do not apply any
creams or lotions on the day of injection.
c.
Eat
a light breakfast or lunch an hour or so prior to your appointment.
d.
Bring loose shorts to wear during the procedure and slacks to wear out
of the office if you prefer.
e. Call our office two or three days before your appointment to be sure
your hose have arrived.
12. What should
I do after the procedure?
a. Walk for 30 minutes immediately
following the injections.
b. While riding home, keep legs moving.
Tense up and relax your muscles. Make
frequent stops for walking (every 20 minutes) if it’s a long drive.
c. Maintain normal daytime activities;
walk at least an hour a day - the more the better.
d. No hot baths for 2 weeks.
e. Avoid standing without moving
about. If you must stay in one place,
move your feet and toes frequently.
f.
If
the legs become painful after the injection, walk.
g.
Do
not remove the stockings at all for 3
days and 2 nights. For large veins we
may want to go longer.
h.
Avoid
strenuous physical activity that breaks a sweat (aerobics) for the first 7
days.
i.
After
the first 3 days, you may remove the stockings at night but it is recommended
that you wear them when not reclining for at least 3 weeks. Ideally you would
use support hose the rest of your life.
13.
Remember
that injection therapy is only treating the symptoms. Whatever the cause of your abnormal veins, it
is still there after the injection. New
abnormal veins can form and may recur, requiring future treatments in 1-2
years. Wearing support hose regularly
may reduce the need for repeat follow up treatments.
14.
I
regularly refer to a vascular surgeon for complicated cases. He is willing to consult prior to any
treatment here and is also available to do the injections right from the
beginning if you prefer. His entire
practice is limited to treatment of abnormal veins.
Please review the handout on billing procedures prior to
your visit. In most instances you are
expected to pay on the day of the visit.
Adapted from Dermatology Associates of San Diego
County, Inc.