How can compression stockings help with varicose veins?
Compression stockings work simply by reducing the amount of blood and pressure in the veins. There are various types of stockings available, and some may apply more pressure than others. The main problem with compression stockings is that the blood will return to the veins soon after the stockings are taken off. They also may be uncomfortable for some people, and therefore, they may not worn for long enough to have any benefit.These stockings typically lose their pressure if washed a few times, so they may need to be replaced from time to time.
What is sclerotherapy?
“Sclerotherapy” uses a fine needle to inject a solution directly into the vein. This solution irritates the lining of the vein, causing the vein to swell and the blood to clot. The vein turns into scar tissue that may eventually fade from view. Sclerotherapy is typically used for spider veins and varicose veins that are less than 6 millimeters in length. This is generally offered to patients who have tried compression stockings and leg elevation without much success.Today, the substances most commonly used in the United States for sclerotherapy are hypertonic saline and sodium tetradecyl sulfate (Sotradecol). Aethoxyskerol (Polidocanol) is undergoing FDA testing but has not yet been approved in the U.S. for sclerotherapy. Sclerosing agent or solution is the general term for the substances used for sclerotherapy.In 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 the development of 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.
What are potential side effects and complications of sclerotherapy?
In about 10-%30% of patients treated with sclerotherapy, dark discoloration of the injected area may occur (hyperpigmentation). This usually happens because of disintegration of the red blood cells in the treated blood vessel. In majority of cases, this discoloration will completely go away within 6 months.
Another problem may be the formation of new spider veins near the area that was treated with sclerotherapy. This can happen in about 20% of patients, but these new vessels also typically disappear within 6 months.
More rare complications may include the formation of an ulcer around the injection site and the formation of small blood clots in the small surface veins (superficial thrombophlebitis).
Is sclerotherapy safe for everyone with varicose and spider veins?
Sclerotherapy is generally safe for most people for treatment of varicose veins and spider veins. However, in certain groups of people, sclerotherapy needs to be avoided, including non-ambulatory people (those unable to walk). Other contraindications for sclerotherapy include obesity, blood clots in the deeper veins, allergy to the sclerosing agent, pregnancy, and arterial obstruction (blocked blood flow in the artery near the varicose vein).
What surgical procedures are available to treat varicose veins?
Varicose veins are frequently treated by eliminating the “bad” veins. This forces the blood to flow through the remaining healthy veins. In vein stripping surgery, the problematic veins are “stripped” out by passing a flexible device through the vein and removing it through an incision near the groin. Smaller tributaries of these veins also are stripped with this device or removed through a series of small incisions. Those veins that connect to the deeper veins are then tied off. This stripping method has been used since the 1950’s.
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.
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 incision(s).
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 with the saline solution to minimize the pain.
Can laser be used to treat varicose and spider veins?
Spider veins and small varicose veins can be treated with laser treatment applied from the surface of the skin. The laser applies an intense energy that essentially destroys the small blood vessels in the surface of the skin. Results are variable, and multiple treatments may be necessary to have some benefit. This is generally less invasive than sclerotherapy and vein stripping (no insertion of needles or catheters are required). Possible problems may involve a temporary discoloration of the skin.
Larger varicose veins may be treated with endovenous (inside the vein) catheter ablation or laser surgery. This basically involves inserting a probe (or catheter) into the large vein in the lower leg (saphenous vein) and closing the vein by applying heat generated through laser. This technique has proven to be less painful, and it also has a faster recovery time compared to the vein stripping surgery.
What type of doctors provide treatments for varicose and spider veins?
Doctors providing surgical treatments (stripping and laser ablation) include general and vascular surgeons. Sclerotherapy and laser treatments are 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 the doctors about their experience in performing the procedure you want.
What are the side effects of these treatments?
A patient should carefully question the doctor 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, which can occasionally be 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 treatments can cause scarring and changes in the color of the skin.
How long do varicose vein or spider vein treatment results last?
Many factors will affect the rate at which treated varicose veins recur. These include the underlying diagnosis, the method used and its suitability for treating a particular condition, and the skill of the physician. Sometimes the body forms a new vein in place of the one removed by a surgeon. An injected vein that was not completely destroyed by sclerotherapy may reopen, or a new vein may appear in the same location as previous one.
Many studies have found that varicose veins are more likely to recur following sclerotherapy than following surgery. However, no treatment method has been scientifically established as being free from recurrences. For all types of procedures, recurrence rates increase with time. Also, because venous (vein) disease is typically progressive, no treatment can prevent the appearance of new varicose or spider veins in the future.
Is one treatment for varicose veins or spider veins better than the other?
The method you select for treating venous disease should be based on the physician’s diagnosis, the size of the veins to be treated and the patient’s:
- treatment history
- age
- history of allergies
- ability to tolerate surgery and anesthesia, among other factors.
As noted above, small spider veins cannot be surgically removed and can only be treated with sclerotherapy. On the other hand, larger varicose veins may, according to many studies, be more likely to recur if treated with sclerotherapy.
How can varicose vein be prevented?
Prevention of varicose veins may be accomplished by periodic leg elevation, avoidance of prolonged standing, and wearing elastic support hose. Regular exercise and control of weight can also be beneficial. These measures can prevent or slow down the progression of varicose veins.
