Treatment of Spider Veins - Patient Information

Introduction

Spider veins are very small blood vessels located in the outer layer of skin. The color is either red or blue based upon the capillary anatomy. These vessels are often unsightly in appearance, and sometimes cause discomfort in the skin. Reticular veins are a little larger and are located slightly deeper in the skin. They are blue in color and often are the feeder source to the spider veins. Both veins are treated to improve skin appearance and to eliminate skin discomfort if present. Sclerotherapy is an effective treatment to remove these veins from the skin.

The following information will help prepare you for treatment and assure the best results possible.

Spider veins are caused primarily by genetic inheritance, and may be associated with an underlying vein insufficiency problem. Excess pressure in the larger saphenous veins can be transmitted to the skin, and may lead to dilated reticular and spider veins. The underlying problem is best treated first, in order to reduce the chance that more spider veins will return at a later date. When the cause is corrected, only a few spider veins will appear in subsequent years.

Your initial consultation and examination includes an ultrasound evaluation of the anatomy and physiology of your leg veins. This thorough assessment assures that you will receive proper treatment, not only to eliminate the spider veins but also to correct any underlying problem which may contribute to their appearance.

Once you are scheduled for spider vein treatments, the following preparation will help give you the best results:

1. Spider vein treatments do not require anesthesia of any kind, therefore you may eat and drink as you would in a normal day.

2. If you have needle fright or wish a mild sedative, we can provide that for you. We prefer someone then drive you home after your treatment.

3. The shaved leg is a little easier to treat, allowing better visibility of the small veins. We also recommend that men shave the area to be treated.

4. Oils and creams make the treatments a little more difficult, and we recommend that you do not apply them to your legs on the day of treatment.

5. Bring with you or wear shorts or loose clothing to fit over compression hose. You will be asked to put on your compression hose immediately after treatment.

6. Some medicines should be avoided for several days prior to spider vein treatment. These include aspirin, ibuprofen, plavix, pletal, and coumadin. Iron supplements, green tea, and vitamin E, also should be stopped at least one week before treatment. Please be sure we know the medicines you take even if “natural” meds so that we can advise you regarding your treatment preparation.

Who should not have spider vein treatments

1. Do not have treatments if you are pregnant.

2. You are not a good candidate if your blood thinning medicine must be taken everyday, for instance to protect your heart.

3. If your ability to walk is limited, you should not have treatment.

4. If you are prone to blood clots, or have a known blood clot disorder, your eligibility will be decided on an individual basis.

5. Anyone who has a severe needle fright will not do well with spider vein treatment.

What are the treatment methods?

Spider veins are best treated by a technique called sclerotherapy. This requires the injection of a solution into the abnormal veins. The solution damages the inside lining of the vein, causing the vein initially to clot, and then to scar closed. Once adequately scarred, or sclerosed, the vein will not re-open and will not re-occur.

The two sclerosing solutions most commonly used at the Alabama Vein Center are foamed Sotradecol, glycerin/lidocaine, and polidocanol. All are excellent solutions which give very good results and minimum side effects. 

The injections are not very painful as perceived by almost all of our patients. The needles are very small 30 gauge, and often can barely be felt as they penetrate the small veins. However, many injections are often required, and one must be prepared to accept 2-6 treatment sessions if needed. The solutions will sometimes cause a burning sensation which lasts several minutes. If the discomfort seems excessive, you will receive immediate cold compresses.

We try to treat all veins on both legs, both front and back, at each treatment session. Hopefully there will be fewer veins at each subsequent treatment.

Sclerotherapy treatments are performed by our certified physician assistant.

Recommendations for post-treatment care:

1. You will be asked to wear compression hosiery or compression wraps. These will be applied before you exit the treatment table. You should then wear the hosiery daytime only for an additional 5 to 7 days. This will give you the best results with the least side effects.

2. Immediately after treatment, with your compression wraps or hosiery on your legs, please walk around for about 15 minutes. This helps distribute the solutions, and dilute any solution in the deep veins.

3. You may drive and otherwise participate in all normal activities, with your hosiery on your legs.

4. Please avoid high impact sports and activities for 2 days after treatment. Sometimes you will be asked to wait a longer interval, depending upon the size of veins treated.

What are the expected results?

We hope to ultimately achieve at least 50% or better resolution of all spider veins. This may require several treatments and as long as one year or more. If there are a few scattered spider veins, these usually can be eliminated within 6 months or less. If there are a lot of blue spider veins, the treatment may take one year or longer to achieve desired results. You will be advised of your and our expectations at the time of your consultation.

Are complications possible?

As with any medical treatment, complications can and do occasionally occur. Often these are referred to more accurately as side effects of spider vein treatments. At the Alabama Vein Center, we have worked hard to select the best treatment options available today which cause the least adverse side effects. Some of the side effects possible are these:

1. Pigmentation = blood pigment will often stain the skin after spider vein treatments. The vein will be eliminated, but a brown discoloration will be present where the vein once was visible. These pigments usually go away almost entirely within one year. Iron medication is thought to contribute to an increased incidence of pigment formation.

2. Bruising = common after spider vein treatments. Resolves virtually entirely within 6 to 8 weeks.

3. Skin numbness = nearby skin nerves are sometimes stunned by the treatments. This too nearly always resolves within a few months.

4. Skin ulceration = sometimes the solution will damage the skin excessively and cause a small ulcer. The ulcer will take 6 to 8 weeks to heal, and may require minor skin wound care such as ointments and light dressings. 

5. Veins resistant to treatment, and new veins developing = some veins are more difficult to treat and will not disappear, and occasionally new veins will develop at treatment sites. Both of these problems are rare, and can be treated successfully by additional injections and changing solutions and compression methods.

6. Itching and redness = will develop at treatment sites on occasion. This is not serious, and can be treated with steroid creams on the skin, and anti-histamines if the itching is prolonged.

7. Ankle and leg swelling = occurs fairly commonly after injection treatments, especially if ankle and foot veins are treated. This will disappear usually within a few months. Compression hosiery may be worn in the interim.

8. Blood clots, or phlebitis, will develop in some of the larger treated veins. This is normal and is the desired result of treatment. The veins will feel lumpy or knot-like, and are often associated with tenderness and redness of the skin. This too will go away within two to four months or longer, and is treated with ibuprofen or other anti-inflammatory medication.

9. Deep vein blood clots = rarely occur after spider vein treatments. Compression hosiery and walking for about 15 minutes after your treatment will help minimize this possibility.

The cost of spider vein treatment and insurance coverage can be summarized as follows:

1. Spider vein treatments are considered cosmetic and are not covered by insurance.

2. Each spider vein treatment is $400. A treatment includes sclerotherapy (injection) of spider veins on both legs, front and back, and including the ankles and feet.

3. The number of treatments required is difficult to estimate. Our staff will provide for you our best judgment regarding the number of treatments. Usually, the interval between treatments is two to three months.

4. Please note our policy regarding appointment cancellations. Except for true emergencies, we respectfully request you notify us 72 hours prior to an appointment cancellation.

Thank you for seeking consultation and treatment with the Alabama Vein Center in Birmingham Alabama. Our efforts are to offer you the best and safest treatment options available today. If you have questions, please call or e-mail for answers and we will be pleased to respond. Be patient as we observe the results of treatment, for often several months must pass before we see the results we all desire. We look forward to working with you as we provide this specialty care for your vein problems.