Spider Veins and Varicose Veins
What procedures are available to treat varicose and spider veins? continued...
Spider veins cannot be removed through surgery. Sometimes, they disappear when the larger varicose veins feeding the spider veins are removed. Remaining spider veins also can be treated with "sclerotherapy." Sclerotherapy uses a fine needle to inject a solution directly into the vein. This solution irritates the lining of the vein, causing it to swell and the blood to clot. The vein turns into scar tissue that fades from view. Some doctors treat both varicose and spider veins with sclerotherapy. Today, the substances most commonly used in the U.S. are hypertonic saline or Sotradecol (sodium tetradecyl sulfate). Polidocanol (aethoxyskerol) is undergoing FDA testing but has not yet been approved in the U.S. for sclerotherapy.
During sclerotherapy, after the solution is injected, the vein's surrounding tissue is generally wrapped in compression bandages for several days, causing the vein walls to stick together. Patients whose legs have been treated are put on walking regimens, which forces the blood to flow into other veins and prevents blood clots. This method and variations of it have been used since the 1920's. In most cases, more than one treatment session will be required.
Do these procedures hurt?
For all of these procedures, the amount of pain an individual feels will vary, depending on the person's general tolerance for pain, how extensive the treatments are, which parts of the body are treated, whether complications arise, and other factors. Because surgery is performed under anesthesia, pain is not felt during the procedure. After the anesthesia wears off, there can be some pain at or near the incisions.
For sclerotherapy, the degree of pain will also depend on the size of the needle used and which solution is injected. Most people find hypertonic saline to be the most painful solution and experience a burning and cramping sensation for several minutes when it is injected. Some doctors mix a mild local anesthetic in with the saline solution to minimize the pain.
What type of doctors provide treatments for varicose and spider veins?
Doctors providing surgical treatment include general and vascular surgeons. Sclerotherapy is often performed by dermatologists. Some general, vascular, and plastic surgeons also perform sclerotherapy treatments. You may want to consult more than one doctor before deciding on a method of treatment. Be sure to ask doctors about their experience in performing the procedure you want.
What are the side effects of these treatments?
Carefully question doctors about the safety and side effects for each type of treatment. Thoroughly review any "informed consent" forms your doctor gives you explaining the risks of a procedure.
For surgical removal of veins, the side effects are those for any surgery performed under anesthesia, including nausea, vomiting, and the risk of wound infection. Surgery also results in scarring where small incisions are made and may occasionally cause blood clots.
For sclerotherapy, the side effects can depend on the substance used for the injection. People with allergies may want to be cautious. For example, Sotradecol may cause allergic reactions, occasionally severe. Hypertonic saline solution is unlikely to cause allergic reactions. Either substance may burn the skin (if the needle is not properly inserted) or permanently mark or "stain" the skin (these brownish marks are caused by the scattering of blood cells throughout the tissue after the vein has been injected and may fade over time).
Occasionally, sclerotherapy can lead to blood clots. Laser and electro-cautery treatments can cause scarring and changes in the color of the skin.