Treating varicose veins with sclerotherapy

Unwanted leg veins (spider veins), known medically as telangiectasias or superficial varicosities, are dilated skin capillaries. These may become unsightly with time and may also lead to a dull aching of the legs after prolonged standing.

No one is totally sure what causes varicose veins. Certain families are predisposed to this condition, particularly female relatives. Certain things make spider vein worse: estrogens, pregnancy and birth control pills, tight girdles and garter belts, prolonged standing and sitting, and trauma. Severe varicose veins can compromise the nutrition of the skin and can lead to eczema, inflammation and or even ulceration of the leg.

The good news is with the evaluation of and treatment methods available today, spider veins and varicose veins, regardless of size and shape, can be treated at a level of effectiveness and safety previously unattainable.

The most useful and practical instrument, the handheld Venous Doppler, is used for evaluating venous disease. The Doppler detects evidence of reflux from deep and superficial veins. If reflux is present, a patient is referred to a vascular surgeon for further assessment and possible surgical correction of venous problem of the affected limb. However, after surgery, there remains the residual veins.

Sclerotherapy is the technique of instilling a specific solution into these vessels (tiny capillaries or larger varicose veins), using a small needle which causes the vein to collapse and get reabsorbed. With this procedure, veins can be dealt with at an early stage, helping to prevent further complications such as eczema or ulcer formation. Most patients are happy with the disappearance of pain and cosmetic improvement of their legs.

A recent advancement in sclerotherapy is the foam technique, which is now used to treat even large and multiple convoluted large veins that cannot be completely corrected with surgery or vein stripping. The foam causes the sclerosing solution to act more efficiently with the lining of the vein for a more effective treatment. The surface veins are no longer visible. This does not harm the circulation – it improves it by eliminating the abnormal, unnecessary vessel. Fading of the vessels is slow, which takes one week to six months.

In the experience of Dr. Julieta Peralta-Arambulo, a consultant at The Medical City, Medico Building, Manila East Medical Center, and the Skin and Cancer Foundation of the Philippines, there is 80 to 100 percent improvement after the first session depending on the size, type and number of veins being treated. She tries to treat all the veins in one session following the maximum daily recommended dose of sclerosing solution.

The therapeutic efficacy of sclerotherapy is enhanced when the bigger veins are treated prior to smaller veins. Arambulo uses the Translite Veinlite to identify or map the feeder veins in difficult cases, with progressive spider veins that follow an irregular arborizing or cartwheel pattern.

With this technique, sclerotherapy is done with ease and enables treatment of feeder veins that cannot be seen because they are below the skin. This Veinlite-guided sclerotherapy increases the success rate of the treatment.

The presence of varicose and telangiectatic veins is not a normal physical finding, but a medical disease deserving treatment.

Sclerotherapy is the gold standard of treatment of varicose veins, spider veins and residual veins after surgery. Certain types of varicose veins may not respond readily to sclerotherapy alone. These vessels may require a minor surgical procedure, followed later with sclerotherapy. Patient may be referred to a vascular surgeon for complete or partial treatment of these large varicose veins.

Sclerotherapy can complement surgical treatment of varicose veins and is an effective modality for varicose veins if surgical treatment is contraindicated.