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SCLEROTHERAPY

Many people, especially women, suffer from "spider veins" on their legs. These veins are often unsightly and sometimes painful. They are abnormal and serve no function, therefore their removal does not impair circulation.

Sclerotherapy is the treatment of choice for spider veins on the legs. (Large varicose veins may require surgery.) A solution is injected into the veins causing them to disappear slowly over several weeks. Several treatments are usually necessary to completely remove them.

Sclerotherapy requires great skill and finesse to be done well. Side effects are rare and results excellent when performed by a physician highly experienced in this technique. Dr. Klein is one of the most experienced doctors in this technique in Orange County.

Q & A ABOUT SCLEROTHERAPY

• 1. What is used?
  A concentrated saline solution.
• 2. How does it work?
  The solution works by drying out the tiny cells, which line the blood vessels.
• 3. What are the side effects?
  1. 95% of the patients have none. Slight stinging or pain can sometimes be felt when the solution is being injected however.
  2. Pigmentation. Occasionally a small freckle-like pigmentation can occur. This usually fades but may rarely persist indefinitely at the injection site. With good technique, this only occurs rarely with the small spider veins. It has a higher risk of occurring with treatment of the larger veins.
  3. Bruising. Occasionally when the vessels are very weak, bruising can result which usually only lasts 1-2 weeks.
  4. Sometimes a clot can develop at the injection site. This clot will never cause any internal problems, but its removal within 2 weeks of the injection will speed up the healing process.
  5. Swelling is occasionally noted. It is particularly common when patients have jobs in which they stand for long periods of time or in which vessels in the ankles or lower portion of the leg are involved. The swelling is never dangerous, but occasionally must be treated with elevation and compression dressings.
  6. Superficial thrombophlebittis. This is an irritation of the vessels closest to the skin. It sometimes must be treated with anti-inflammatory agents and bed rest. This probably occurs in less than 1 case per 1000. An even rarer risk is a deep clot (deep vein thrombosis) which can be serious. Luckily this is extremely unlikely.
  7. Very rarely, ulceration may form at the site of injection. This heals with small scar.
• 4. How soon will the vessels disappear?
  Each vessel may require 2 to 3 injections. Usually the vessels disappear over a period of 2-4 weeks. You must be patient. This is a gradual process. Also, This treatment does not prevent new veins from developing.
• 5. How much does it cost?
  The cost is related to the amount of time spent. The usual session is 15 minutes long. I can perform about 80-100 injections during this time period.
• 6. Will my insurance reimburse me for this procedure?
  This procedure is sometimes covered by medical insurance. It may be considered a cosmetic procedure. Insurance companies vary as to their policies. You can check with your company in advance or go through one treatment session and see if they reimburse you. Because insurers may not pay, payment is expected on the day the procedure is performed.
• 7. Why do they exist?
  No one is totally sure, but certain families seem predisposed, particularly the female relatives. Also mechanical trauma, falls, long periods of standing or sitting, as well as pregnancy and hormones may play a role.
• 8. Is there a way to prevent them?
  The use of support hose may be helpful. Reducing you weight and exercising may also help.
• 9. Are there any special instructions after the procedure?
  The major concern immediately after the procedure has to do with bleeding. Strenuous physical activity or prolonged periods of standing should be avoided for the first 48 hours after treatment. Walking is allowed. Cotton balls are taped on the treated areas and must be kept on for 3-5 hours after the treatment. For larger veins, support hose is sometimes recommended. No bandages are necessary.
• 10. How often can I be treated?
  It is preferable to inject the same area after about 2 to 4 weeks of healing.
• 11. How many times does it have to be done?
  This varies with the number of areas that have to be injected, as well as the response to each injection. It usually takes 1 to 3 injections to obliterate any vessel. 
• 12. How should I dressed for the first procedure?
  Wear a loose skirt, shorts or loose pants. You may wear a bathing suit or leotards under your clothes if you desire.
• 13. Do I need to prepare my legs before the procedure?
  Do not use moisturizers or oils on your legs that day.
• 14. Are there certain kinds of spider veins that cannot be treated?
  Generally speaking, the larger the vein the more difficult it is to eradicate. Large, bulging, "ropey" varicose veins are often best treated with surgery. Small vessels on the face, trunk and arms are better treated with electrosurgery (which can be done during a regular office visit).
• 15. Is this method superior to lasers?
  This procedure leads to less scarring than with lasers. The laser is an expensive device and the treatment is more costly. Lasers do not work as well as sclerotherapy for the treatment of leg veins.
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