TREATMENT OF BLOOD VESSEL BLEMISHES OF THE THIGHS AND LEGS (SPIDER VEINS)

To print: Click here or Select File and then Print from your browser's menu.

Unsightly blood vessel or venous blemishes of the legs are called by many names. Broken blood vessels, broken capillaries, star burst blemishes, small varocosities, or just plain leg veins are many of the terms used to describe these. They are usually very small, fine spidery or snake-like blood vessels running very close to the surface of the skin. Because they are so close to the skin they have a very obvious red or purple-blue appearance. It is because of this obvious color, that cannot be covered with makeup, that women wish these vessels be removed.

For at least twenty years physicians in this country and Europe have used many different substances to inject into these blood vessels to eradicate them. The trouble with most of these methods has been the possi bility of significant allergic reactions, a significant high percentage of pigmentation or brown spots left after the treatment, or even intense reactions causing depressions and scars that are quite significant after the treatment. All these complications were seen because of the types of irritating materials used. Over the last few years the use of hypertonic salt (saline) solution has been a significant advance over the previously used materials, making this method more likely to be used by physicians who would have been concerned with side effects by previous methods. Because salt is a natural body component there is not the concern for allergic reaction as there would be to previously used foreign materials. The salt is simply a stronger salt solution (23% NaCI) that will cause enough irritation of these little blood vessels to cause the vessel walls eventually to stick together, thus completely closing them off or partially closing them off. This results in either a very much lighter color and appearance to the vessels or complete disappearance.

QUESTIONS FREQUENTLY ASKED:

1. What can I expect during injections?

A. Since only a very fine gauge needle is used, at most this needle feels like a small mosquito bite. It would certainly not be described as typically painful.

B. Fifteen to thirty seconds of mild discomfort or burning at the site of the injection may be experienced. Some patients may also experience a local muscle cramp which usually will only last a few minutes.

C. A temporary flushing around the blood vessel which is expected in 100% of cases is seen.

2. How soon will the blood vessels disappear?

A. As mentioned above, the vessels will either lighten or completely disappear. This fading usually appears over the first month but may take as long as two or three months for some vessels. Of course, this does not keep new vessels from coming out which have been coming out for a period of years, but only treats the vessels that have been injected.

3. If I wanted thirty vessels treated would I have to have thirty injections?

No. Since many of these vessels interconnect, one tiny injection site may eradicate several dozen obvious blood vessels at one time (sometimes less than one minute). This is a distinct advantage of this method as opposed to methods that may treat isolated vessels at one time.

4. What kinds of side effects can be expected?

A. As mentioned above, allergic side effects should not be seen. A small amount of salt solution will usually seep outside the blood vessel into the surrounding skin. This in fact happens to a small degree with all injection sites because we continue to Infiltrate solution until a small amount seeps out. This tiny bleb that results in the skin usually heals quickly but may in some circumstances result In a small crust that may leave a small brown spot. This is not significant and will usually disappear, but sometimes may leave a permanent small brown spot. In almost all circumstances this is much less obvious than the original blood vessels that were there. If such a small scab results, do not pick at it. Occasionally, a depressed scar may result— a good reason for doing a few vessels at a time to see how they react.

Also some mild or moderate bruising may be seen depending on how fragile the blood vessels are. As with all bruises it may take a few weeks for them to clear.

Sometimes a very small coagulum of blood develops at the injection site and may become tender. If this happens the patient should let us know so that we can gently remove this coagulum to relieve the inflammation. This is simply a small amount of coagulated blood that is accumulated when the vessel wall comes together.

A leg ulcer or infection is a possible, but unlikely side effect (see #14).

5. How often should I receive treatments?

A. Different sites can be treated at 2-4 week intervals. I would not retreat any one specific area until at least four weeks have elapsed. Retreatment should only be done if vessels have not lightened significantly.

6. How many treatments would be necessary?

A. This is easier to tell after the first session at which both the patient and the doctor can see how many blood vessels are blanching and how quickly they disappear; however, the average is four to twelve treatment sessions to obtain a reasonable pleasing cosmetic effect.

7. Will every single venous or blood vessel blemish disappear?

A. No. In most cases the larger, conspicuous blemishes will either be lighter and smaller or possibly invisible. Many of the smaller ones will disappear completely. The cosmetic improvement is usually quite gratifying to most patients but may not be 100%. This rarely discourages patients from seeking treatment once they have seen the cosmetic results.

8. What other methods would be available to treat these?

A. We can use a very light electrosurgical method where we use a fine electric needle and current; however, this has to be done multiple times to every blood vessel. It also is more likely to leave tiny white spots. We would not use other chemicals that I mentioned because of irritating or allergic qualities.

9. What is the cause of these blemishes?

A. This is not known but is obviously much more common in females. A familial predisposition, pregnancy, obesity, trauma, long periods of standing, sitting, etc. have been implicated. Hereditary tendency is probably one of the most significant factors.

10. Is there any way to prevent these from coming out?

A. Some doctors would support exercise and weight loss in addition to the use of support hose to limit the number of new vessels, but would hardly keep a predisposed female from developing any at all.

11. Are there any special instructions just before the procedure?

A. Simply take a good shower or bath and make sure the legs are clean; however, do not shave your legs immediately before coming in for treatment.

12. What should I wear before treatment?

A. It would be more convenient for the patient to wear shorts or clothing that may be easily rolled up to clearly expose the area to be treated. No particular clothing or dress is necessary, as drapes may be provided.

13. What are the post treatment instructions?

A. Flexible fabric bandaids will be placed on the area and should remain until the following morning at which time the patient removes them. A quick shower for the first 48 hours is acceptable but prolonged soaking in a hot bath is not advised. Only contact sports or excessively strenuous physical activity should be avoided for the first 48 hours. We would prefer the area not traumatized. Do not refrain from normal activity, as this is healthy for normal venous flow. Do not pick any scabs with your fingers. You may wear anything you like. Keep the area clean for the first week after treatment.

14. Are there any previous medical conditions I may have that would contraindicate this therapy?

A. Patients with a history of inflammation of the veins (thrombophlebitis) or blood clots in the legs (usually resulting from thrombophlebitis) should not have this treatment. Although theoretically there should not be any connection between treating these very superficial skin vessels and thrombophlebitis of larger vessels, we prefer not to treat such patients. There have been no reported cases of thrombophlebitis or blood clots of deeper vessels from this treatment and there should be no theoretical reason for such. Despite this, we still prefer not to treat patients with such history. There is no absolute contraindication for patients with blood pressure or other salt related problems because of the small quantity of salt used in this treatment; however, we want a written OK from the patient's internist or general physician indicating he sees no problem with using 3.0 cc or less of 23.4% saline during treatment. The patient should continue to use any blood pressure medication they use and to follow the low salt diet prescribed by their doctor.

An infrequent, but possible side effect could be the formation of a leg ulcer at an injection site. We do not treat patients with a personal history of diabetes, arterial or other vascular problems in the legs, or previous leg ulcers. In such patients, any light trauma (including leg vein injections) can start a leg ulcer. Other patients could develop such an ulcer, but it would be much less likely.

15. What is your overall impression, doctor, of this treatment?

A. This new saline technique is a very welcome treatment for a condition that was usually untreated before. I have been quite satisfied with its safety and effectiveness.

I have thoroughly read the above information sheet and will again read it thoroughly each time after treatment. The doctor has answered any and all questions which I may have concerning this treatment.