SCLEROTHERAPY (Vein Injections) for
TELANGIECTASIAS (Spider Veins) of the LOWER EXTREMITIES

ABOUT THE PROCEDURE
Telangiectasias are small blood vessels in the surface of the skin, scattered throughout the lower legs, or other areas, which are less than 1-2mm. in diameter. Heredity, skin characteristics, activity (sedentary vs. ambulatory), pregnancy, and physiologic fluctuations in hormonal levels all contribute to the visibility, prominence and recurrence of the small vessels pre and post treatment. The primary treatment for lower extremity spider veins consists of injection with a sclerosing agent, which irritates the vessels and causes blood to clot within them. Subsequently the body, with an inflammatory response, dissolves the clot and collapses the vein with scarification of the vessel wall. The overall effectiveness of sclerotherapy for surface telangiectasias is about 60-70%. Some of these vessels recannulate and recur over a period of several weeks to months. The whole process of obliteration takes 3-4 months to complete its cycle. In general, there is improvement immediately with less visibility of the vessels. Repeat procedures, when needed, can be undertaken at 4-6 month intervals to address those vessels that have not completely responded or new vessels.

Injection therapy is to some degree self limited, in that the residual vessels become smaller and smaller in diameter and are unable to be cannulated with even the smallest hypodermic needle. These types of vessels are best treated with vascular laser therapy. Some types of leg telangiectasias are best treated by vascular laser initially. Blue vessels, especially on the legs, are best treated with a Yag laser if injection therapy is not appropriate. Facial telangiectasias (fine, red superficial vessels) are best treated with vascular laser versus injection sclerotherapy, as injections into facial vessels are dangerous. Injection therapy and Yag laser treatment for lower extremity spider veins are complementary procedures whose application must be individualized to clinical circumastances and desires.

RISKS
Potential risks of this procedure include small areas of skin discoloration or scabbing which may take several weeks to completely resolve. The agents used for sclerotherapy are fairly hypertonic and concentrated and can damage the skin at the injection sites, especially if post operative instructions are not followed, including elevation of the extremities and limitation of activities for the first 12 to 24 hours. There are also times when the minor bruising that is associated with injection therapy can remain for longer periods of time. This has been noted to occur for up to six months. If any significant residual scarring or areas of pigment remain for long periods of time, the option for these would be subsequent excision of the area and suture closure. This is rarely necessary.

POST TREATMENT
The postoperative instructions should include elevation of the lower extremities as much as possible for the first 12 hours after injection therapy has been completed. Elevation can be lying in bed or raising the legs on a footstool or in a chair. It is also important to utilize heavy support hose that are applied immediately after the injection therapy session and should be worn for 4-5 days continuously. Support hose (compression stockings) are recommended, but not required for laser treatment of leg vessels. They can be used for comfort and to control swelling for 7-14 days after treatment as needed for leg treatments.

Normal daily activities can be resumed the day following treatment. Prolonged standing or leg dependence should
be avoided for 6 weeks following treatment, as this will prolong the initial mild swelling that occurs following the injections, but that should be mostly resolved by 10-14 days. Regular exercise can be resumed as tolerated, usually within 4-5 days post treatment. If evidence of infection, such as drainage, redness, or unusual swelling occurs in the treated areas, then I would expect you to immediately return to the office for evaluation.