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What are Spider Veins?
These are small veins which appear on the legs, chest, and facial areas. They are hereditary, occur from sun damage and occasionally from trauma like a cut or deep bruise. Small valves within the vein leak resulting in the presence of the dilated complex on the skin.
Are they dangerous?
As a general rule they are not dangerous. However, some spider veins, like those on the inside of the thigh, calf or ankle can occur due to reflux or leak in the saphenous vein. In older patients they can erode the skin and cause bleeding. Only expert evaluation with duplex imaging can determine the underlying cause and select the correct treatment.
How are they treated?
With today’s technology advances we are able to utilize treatments that allow us to more rapidly and less invasively remove both spider vein complexes and large and small varicosities. All treatments are performed in the comfort of an office setting, with no need to go to a surgical center or outpatient hospital setting.
Spider vein complexes respond very well to a combination of laser therapy and sclerotherapy. The laser utilizes light energy to clear the visible surface vein, with sclerotherapy (which is the use of an injection agent) to rid the underlying feeder vein. On facial vein complexes the laser alone is all that is usually required.
Sclerotherapy involves injection of an agent into small veins, usually less than 4 mm, to cause the vein to stop working. The target veins are spider veins or the veins feeding spider complexes. Small valves leaking in the vein cause these complexes. In order to resolve the presence of the vein, the flow of blood has to be stopped. The agent causes damage to the lining of the vessel, which results in the stoppage of blood flow. It is diluted very quickly and treats only the short segment it is injected into without injuring veins outside of the area of injection. This a positive feature of injection, preventing the complication of damaging veins which are functioning. Due to the variable number of feeding veins causing spider complexes, it can take 3-4 treatment sessions to resolve the veins. Initially, after treatment the area will appear bruised and may be darker due to some trapped blood in the vein that has been shut down. Sometimes the blood is aspirated to speed resolution. Hemosiderin is a component of blood that can result in temporary brown staining on the skin. This will fade if it occurs, though it can take 3-6 months on average. To limit staining it is important to avoid sun tanning, sun tanning products (self tanners), and tanning beds for 2 weeks before treatment and 4 weeks after treatment.
The day of treatment you will wear support hose home to assist in shutting down the injected veins. Support hose are to be worn during the day for the next 7 days. Exercise is limited to walking for 7 days, to prevent increased blood flow.
Sclerotherapy is a very effective method of resolving spider veins. Often complimented with superficial laser treatment. But it is important to understand there IS NO QUICK resolution to cosmetic veins. They require multiple treatments and time to resolve after treatment. Short time for resolution is 1 month but take 3 months or more to achieve maximum resolution. When patients are interested in resolving cosmetic vein before the “bathing suit season” it is important to start treatments several months before to allow cosmetic recovery.
Laser therapy involves the use of light energy to shrink or close superficial veins, usually 2 mm or less. There are multiple types of laser that can be utilized, however the most effective and safe lasers are those that are designed for the target (treatment area) the medical professional is trying to treat. For veins hemoglobin and water are the 2 primary targets. Each of these components of blood has specific wavelengths of light absorptions. The laser is chosen to be as close to the wavelength to cause the target to absorb the light energy and limit energy absorption to surrounding structures. This allows optimum treatment with limited risk of damage to surrounding tissue.
On spider complexes laser is best used with sclerotherapy. The laser will treat the very fine vessels thus limiting the amount of sclerotherapy needed, however, sclerotherapy is still the principle treatment modality. Rarely is laser alone effective for long term management of spider veins.
Facial veins, rosacea, and fine veins on the neck and chest caused by sun damage respond very well to laser treatment alone.
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