Let’s face it, the majority of us have discovered spider veins on our legs and this can be very distressing at first glance. It is estimated that more than 40 million Americans suffer from varicose veins, whether visible or in the early stages of development. A more alarming statistic is that approximately 50% of individuals over the age of 50 have this disease. The prevalence of varicose veins tend to be more common in women at 55% compared to men at 45%. Nearly 50% of those who suffer from this disease have a positive family history. Varicose veins tend to be strongly inherited through our parents. If one parent is affected, daughters may have up to a 60% chance while sons have approximately a 25% chance of developing this disease. If both parents are affected, your chances of developing varicose veins is approximately 90%. These statistics are alarming but there is hope.
Sclerotherapy first became popular in the early 1900s and physicians have been treating this disease with much success over the years. Before we discuss sclerotherapy in detail, I think it is very important to first recognize the difference between varicose veins and spider veins.
What is the difference between varicose and spider veins?
The term “varicose vein” tends to refer to the larger, compressible, bluish, veins that develop on the legs and sometimes appear like “worms under the skin”. These often occur due to the presence of “abnormally functioning valves” within the veins. These valves function to push venous blood back up to the heart. When these valves do not work properly, the blood tends to pool within the vein causing the vein to expand, resulting in the development of varicose veins. Spider veins, on the other hand, are often referred to as tiny, red to purple vessels that tend to extend outward like a tree branch under the surface of the skin. Spider veins are a tertiary extension of blood flow that forms near the surface of the skin when the pressure in the underlying large veins builds up over time. The body forms these vessels in the attempt to lower the pressure in the lower legs and this leads to the vicious cycle of newly developing spider veins.
Both varicose and spider veins can be treated successfully but several points need to be emphasized. The majority of people who have visible spider veins have some form of venous disease that may not be visible on the skin’s surface. Our circulatory system in our legs consists of vessels which vary in size ranging from very large arteries and veins to microscopic capillaries. The reason this is so important is that the appearance of spider veins is often a late-presenting sign of underlying varicose veins or vessel disease. It is often recommended that the larger vessels are treated first followed by the treatment of smaller vessels. This top-down approach helps ensure that the primary cause of the veins is targeted before treating the tertiary signs of the disease. With that said, some people do not have large visible varicose veins under the skin’s surface and are good candidates for the treatment of the smaller, visible spider veins.
What is sclerotherapy?
Sclerotherapy is a procedure that utilizes various forms of injectable solutions that are injected directly into the blood vessel where they exert their effects. Solutions can be in the form of a liquid or a foam and vary based on their concentration and composition. Sclerotherapy causes direct damage to the blood vessel walls, leading to eventual closure and elimination of the unsightly spider veins. For larger vessels, the foam may be more beneficial as it increases the surface area and contact with the blood vessel, leading to quicker resolution.
Types of injectable sclerotherapy solutions
Like I mentioned earlier, there are various injectable sclerosing agents on the market. Your physician will select the right one for you depending on the extent of your case.
- Hypertonic Saline
- In essence, a very concentrated form of salt water – 23.4% Sodium Chloride
- Causing cellular dehydration of the blood vessel wall, leading to the destruction of the vein
- Used primarily on small, low-flow spider veins
- Advantages: cheaper; readily available
- Disadvantages: moderate discomfort; more treatments may be required
- Polidocanol and sodium tetradecyl sulfate (STS)
- Extract cell-surface proteins from the blood vessel wall leading vessel closure
- Used on both small and large vessels and can be foamed
- Advantages: can be foamed; slightly more effective; minimal discomfort
- Disadvantages: expensive; rare risk of allergic reactions
- Chemical Irritants
- Used on very tiny spider veins
- Corrosive and toxic to cell surface proteins leading to cell wall death and vessel closure
- Advantages: few associated risk; minimal discomfort
- Disadvantages: one of the mildest sclerosants; require more treatment sessions; not readily available
How many treatments should I expect?
Foam sclerosants are more effective due to the increased strength and surface area within the vessel, thus 2-3 treatment sessions are commonly sufficient. Liquid sclerosants often take up to 3-4 treatment sessions to produce effective vessel clearance.
What are the most common side effects?
- Bruising (can last up to 2-3 weeks)
- Swelling at the injection site
- Injection pain
As discussed previously, valves within the veins are often not functioning properly. This inevitably leads to an increase in pressure in the lower leg, which contributes to the development of spider veins and worsening of varicose veins. One important recommendation after having sclerotherapy is the application of compression to the lower legs. Studies have shown that post-treatment compression improves the clinical clearance of vessels and reduces the risk of pigmentation and bruising. The consensus is that lower leg compression is an integral part of the treatment program and should be started immediately after treatment. Compression can be in the form of compression stockings or a leg wrap. The best option for you will be determined by your physician. Compression should be worn for the first 24-48 hours following treatment.
Where can I have sclerotherapy performed?
It is highly recommended to see a physician trained specifically in sclerotherapy. These include Board-certified Dermatologist, Plastic Surgeons, and Vascular Surgeons. Click HERE to locate your nearest Board-certified Dermatologist for a personalized consultation.
- Weiss MA1, Hsu JT, Neuhaus I, Sadick NS, Duffy DM. Consensus for sclerotherapy. Dermatol Surg. 2014 Dec;40(12):1309-18.
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