The
“We treat
people, not just problems.”
John
L. Pfenninger, M.D.
Lori
Oswald, P.A.-C.
(989)
631-4545
Visit
our Web site 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.
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TURN PAGE
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:
1.
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.
2.
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.
3.
Surgical ligation and stripping
This operative procedure
is carried out in an operating room. It
is best reserved for large varicose veins.
4.
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?
1.
Slight
stinging or burning may occur with
injection of certain types and concentrations of solutions in certain areas.
2.
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.
3.
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.
4.
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.
5.
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.
6.
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.
7.
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.
8.
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?
1.
Discontinue
aspirin and blood thinners 1 week prior to your appointment.
2.
Do
not shave your legs for 2 days prior
to your appointment. Do not apply any
creams or lotions on the day of injection.
3.
Eat
a light breakfast or lunch an hour or so prior to your appointment.
4.
Bring
loose shorts to wear during the procedure and slacks to wear out of the office
if you prefer.
5.
Call our office two or
three days before your appointment to be sure your hose have arrived.
NEXT PAGE PLEASE
12. What
should I do after the procedure?
1.
Walk
for 30 minutes immediately following the injections.
2.
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.
3.
Maintain
normal daytime activities; walk at least an hour a day - the more the better.
4.
No
hot baths for 2 weeks.
5.
Avoid
standing without moving about. If you
must stay in one place, move your feet and toes frequently.
6.
If
the legs become painful after the injection, walk.
7.
Do
not remove the stockings at all for 3
days and 2 nights. For large veins we
may want to go longer.
8.
Avoid
strenuous physical activity (aerobics) for the first 72 hours.
9.
After
the first 2 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.
1.
Remember
that injection therapy is only treating the symptoms. Whatever the cause of your abnormal veins is,
it's 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.
2.
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.
Sclerotherapy Patient
Ed/lmed/2005