We have compiled a list of questions that propsective patients often ask. If you should have a question that is not in this page, please do not hesitate to give us a call or send us a message via the contact page.
What causes these blood vessels to become visible?
How are dilated blood vessels on the legs treated?
Why compression stockings after treatment?
How successful is sclerotherapy?
What are the side effects of the treatment?
Are there other treatment methods?
What should I do before my appointment?
What I should do after the treatment?
What causes these blood vessels to become visible? (back to top)
The cause is not known except that in many cases they seem to run in families. Varicose veins occur in both men and women, but more frequently in women. The hormone estrogen may play a role in their development, because puberty and pregnancy often seem to bring them on. During pregnancy the enlarged uterus may restrict blood flow contributing to their development. Spider veins may also occur after trauma or as a result of wearing tight hosiery or girdles.
They also appear to be associated with obesity and occupations involving prolonged standing. Invariably, spider veins occur with underlying associated varicose veins often not obvious to the patient due to their location under the skin. When they occur on the face, spider veins may be associated with exposure to sun and extremes of temperature. They tend to occur either on the nose or cheeks of fair skin persons.
Can they be prevented?(back to top)
There is no known method of prevention. Wearing specialised venous support stockings may prevent some dilated blood vessels from developing in some people. Maintaining a normal weight and regular exercise, especially walking, may also be helpful. Avoid wearing high heeled shoes as these affect the proper functioning of the larger veins by restricting ankle movement.
How are dilated blood vessels on the legs treated? (back to top)
In the majority of cases, a procedure called sclerotherapy is used in which a solution, called a sclerosing solution is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930’s and long before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together. Over a period of weeks the vessel fades from view, eventually becoming barely, or not at all, visible.
Depending on its size, a single blood vessel may have to be injected more than once, some weeks apart, but in any one treatment session a number of vessels can be injected. This may involve up to 30 injections in one session.
The solutions used vary somewhat with the size of the vessel to be injected. Your doctor will decide the solution that is best for your particular case. Larger varicose veins often underlie spider veins.
In such cases, we believe these vessels should be treated before the spider veins; either by sclerotherapy ultrasound guided sclerotherapy or by Endovenous Laser Ablation followed by compression. The type of treatment necessary is determined by the vascular ultrasound examination which gives a precise diagnosis of any major superficial vein abnormalities.
Why compression stockings after treatment? (back to top)
Following each treatment session with sclerotherapy you will be required to wear a special venous compression stocking to assist in sealing off the dilated veins. The length of time that the stocking will be required to be worn continuously varies from one day to two weeks and will be determined by size of the veins injected and the abnormalities detected on the ultrasound scan. It is very important to adhere strictly to the duration of compression advised by your doctor in order to obtain the best result. Compression minimises formation of blood trapping and pigmentation, reduces the number of treatments necessary, reduces the risk of deep venous thrombosis and reduces the possibility of reoccurrence. Tape dressings instead of support stockings are sometimes used over very fine veins.
How successful is sclerotherapy? (back to top)
After several treatments, most patients can expect a 70% to 80% improvement in treated vessels. The fading process is gradual with treated veins slowly fading up to three months after the last treatment.
How much does treatment cost? (back to top)
Charges to the patient vary with the condition and the number of treatments necessary. More than one treatment session is usually necessary. Medicare provides a rebate for injection of symptomatic varicose veins larger then 2.5mm in diameter. Purely cosmetic veins are not covered by Medicare or Private Funds. Please ask the doctor, prior to commencement of treatment, the approximate cost of the proposed treatment.
Medicare safety net. Depending on the type of treatment you may be eligible for Medicare safety net. This will be explained to you by the clinic staff on the day of consultation
What are the side effects of the treatment? (back to top)
For surgical removal of veins the side effects are those for any surgery performed under general anaesthesia. These include nausea, vomiting, wound infection and deep vein thromboses.
Side Effects of Sclerotherapy:
a. Transient hyperpigmentation (Brown Staining) Approximately 10% of patients who undergo sclerotherapy notices discolouration (light brown streaks) after treatment. In almost every patient the veins become darker after the procedure. Once the trapped blood is drained after 2 to 3 weeks of treatment, this temporary discolouration settles down.
b. Telangiectatic Matting. This refers to the development of new tiny blood vessels in the region of treated vessel. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 18% of women receiving oestrogen therapy and in 2 to 4% of all patients, this is temporary.
c. Skin ulceration. Sloughing is uncommon. It can happen even in the hands of an experienced physician. It is either due to abnormal connection between small vein and arteries or escape of solution into surrounding skin. Injection ulcers are small and heal very well over weeks at times leaving a small pale scar.
d. Allergic reactions. Very rarely a patient may have an allergic reaction to the sclerosing agent used. This usually presents as a skin rash. At worse (and very rare) an anaphylactic reaction may occur. This is treated by an injection of adrenaline or cortisone.
e. Deep Venous Thrombosis (DVT): DVT may occur occasionally and may manifest itself with pain in the calf or swelling of the ankle or foot. The approximate risk is 1 in 2000 for sclerotherapy and even less in EVLT. Compression stockings and daily walking are very important following the procedure as this significantly reduces the risk. Hormone therapy (i.e. the pill or hormone replacement therapy) is usually stopped before the procedure.
Other minor side effects are* hair growth at injection sites, however this is localised and temporary.
*Migraine sufferers may experience headache or visual disturbance following injection sclerotherapy. Simple analgesics like Panadol, Nurofen or other anti migraine therapy will relieve the symptoms. *Numbness of the skin is temporary and quite uncommon it is due to irritation of the nerves close to the injected vein. At times this may take up to 3 months to recover.
*Intra-arterial Injection is extremely rare (1 in 10000) complication resulting in significant skin and muscle damage. This now rarely occurs as Ultrasound guided injections and constant monitoring of solution during treatment has increased the safety profile.
Will treated veins recur? (back to top)
The veins treated adequately by sclerotherapy will not recur. However, the underlying weakness in your vein walls is not corrected by sclerotherapy and therefore new vessels may appear with time. It is important to maintain normal body weight, exercise regularly, and avoid wearing high heeled shoes to minimise the development of dilated veins. An annual “check-up” is recommended to detect the development of new veins which can then be treated easily.
Are there other treatment methods? (back to top)
a. Lasers occasionally have been used to vaporise small superficial spider veins and small blue veins called venules although when treating leg veins, they can cause scars on the skin as well as pigment changes. The pain with laser is greater than injections and the results are not very satisfactory. The gold standard for superficial veins remains injection sclerotherapy. However, they are effective on barely visible blood vessels under 0.2mm in size. They are especially effective in treating prominent facial blood vessels. Dr Dhillon uses Gemini (dual wavelength 532 and 1064nm) laser for facial veins and occasionally on leg veins in highly selective cases and in others where sclerotherapy is contraindicated due to medical reasons. Ultrasound guided sclerotherapy and Endovenous Laser Therapy is for large bulgy varicose veins.
b. Ambulatory Phlebectomy. This is done as an office procedure under local anaesthesia. The vein to be treated is marked the area is prepared and tiny incisions are given on the skin and the vein is pulled out with special hooks. Stiches are generally not required. After the treatment leg is bandaged. The scarring is usually minimal Surgically tying veins off (ligation) and pulling them out (stripping) are other procedures which is slowly becoming less popular because of general anaesthetics, hospitalisation, downtime and high recurrence rate.
What should I do before my appointment? (back to top)
- Read this information sheet again.
- Do not apply moisturiser to your legs on the day of your appointment.
- You may prefer to wear pants to your appointment as they will conceal the stocking and underlying compression pads.
- Always bring your compression stocking for each appointment its use is vitally important to achieve good results.
What I should do after the treatment? (back to top)
- Follow your doctor’s instructions for the best results.
- Walking immediately after the treatment for 45 minutes and every day while undergoing treatment.
- Avoid standing for long periods of time.
- The duration of compression stockings depends on the type of treatment you are having and your doctor will explain you accordingly and you will be given written instructions to follow.
- Leg waxing can be performed only after a period of two weeks from your last treatment.