Sclerotherapy for Spider Veins
Sclerotherapy is the injection of chemical agents into the vein in order to cause the vein to disappear over time. While superior results are obtained in combination with the application of the transdermal laser (CLaCS), sclerotherapy may at times be used alone.
For sclerotherapy to work an irreversible injury to the blood vessel must occur. This usually induces clotting of the vessel and activates the body’s inflammatory response that over time results in the eventual removal of the blood vessel, the spider vein, and its diappearance. The clots within the spider vein do not migrate or travel via the circulation and therefore are of no health concern or consequence. The time to complete removal of the spider vein and clots is variable. Most spider veins begin to fade within 2 to 3 weeks and most are totally gone by 4 to 6 weeks. Larger veins or ones of the foot or ankle may take considerably longer, up to 2 to 3 months or so, to resolve.
The sclerotherapy agents employed at Dallas Vein Specialists to treat spider veins are safe and cause little if any discomfort. There are several agents that are highly effective and have stood the test of time. These include glycerine, polidocanol, and sodium tetradecyl. All are gentle to the skin, have low allergic potential, and are non-toxic in the concentrations and dosages used. At Dallas Vein Specialists hypertonic saline is not used on account of its potential to cause skin ulceration at the injection site and pain on injection.
While the outcome of sclerotheapy is dependent on the agent used and the skill and experience of the individual performing the treatment, results will vary from patient to patient. Failures will require close scrutiny to ascertain other problems that may account for these failures such as the presence of high pressure in incompetent regional veins such as “feeder veins” or larger superficial or deep veins of the leg. Such problems are often detected before the treatment when the experienced physician at Dallas Vein Specialists initially examines the patient. Often an ultrasound study is done as part of the initial examination to determine if there is any condition that may cause sclerotherapy to fail or the results to be suboptimal.
Sclerotherapy using Foam (Foam Chemical Ablation)
At Dallas Vein Specialists Sclerotherapy using polidocanol or sodium tetradecyl made into a microfoam is sometimes used. These 2 agents have detergent properties, which allow them to change into a foam state when agitated vigorously with a gas such as air or carbon dioxide. The advantage of foam is that the tiny bubbles tend to cling to the inside lining of the blood vessels, and this allows more time for the injurious chemical reaction with the cells lining the veins to occur. Liquid tends to be washed out more rapidly allowing less time for the desired effect, especially in larger veins where blood flow is brisk.
The desired sclerotherapy effect is generally limited to the vein in the immediate and nearby area of the vein injected. Some foam always escapes into other veins including the deep veins of the leg and to the central circulation of the body including the heart and lungs. The foam quickly dilutes and becomes ineffective in the larger veins causing no untoward clotting.
Foam sclerotherapy, sometimes called foam chemical ablation, has been a major advance in the treatment of diseases of the veins. When ablation of incompetent larger superficial veins is called for and these cannot be treated with laser energy or radiofrequency because of technical factors, foam sclerotherapy is the best option. In such cases open surgical procedures are avoided. Foam is easily seen on ultrasound images and thus can be directed using ultrasound guidance into target veins that cannot be seen on surface examination. Foam has allowed vein specialists to treat some debilitating congenital vein conditions that in the past have defied treatment attempts including surgery. At Dallas Vein Specialists foam sclerotherapy has become an indispensible minimally invasive treatment.