Background On Sclerotherapy (Spider Vein Treatment)
A conservative estimate is that from 30 to 60% of adults have spider veins or telangiectasias. The cause of spider veins is unclear. Genetic factors have been felt to play a major role. Sclerotherapy is a popular method of eliminating varicose veins and superficial telangiectasias (spider veins). This technique involves injecting a solution called a sclerosing agent into veins. The injections cause sclerosis or the formation of fibrous tissue in the vessel subsequent to an inflammatory reaction. This process causes a gradual fading of the treated vessel over a period of several weeks to several months. The majority of persons who have sclerotherapy performed will be cleared of their varicosities or at least see a good improvement. Unfortunately, however, there is no guarantee that sclerotherapy will be effective in every case. Approximately 10% of patients who undergo sclerotherapy have poor to fair results. (" Poor results" means that the veins have not totally disappeared after six treatments.) In very rare instances, the patient's condition may become worse after sclerotherapy treatment.
 
The number of treatments needed to clear or improve the condition differs from patient to patient, depending on the varicose and spider veins present. One to six or more treatments may be needed: the average is three to four. Individual veins usually require one to three treatments.

Sclerotherapy Consultation
At your initial consultation with Dr. Capella, he will perform a directed physical examination and take a detailed history including current medications, allergies to medications, and previous attempts to treat spider veins. He will ask extensively about your vascular history including any problems with phlebitis, blood clots, pulmonary embolism and leg ulcers. Dr. Capella will ask if you experience any symptoms with your spider veins such as pain, cramping, fatigue, dull aching, stinging or burning. His physical examination will focus not only on assessing the extent of your spider veins but on your deeper, larger veins as well. Signs of a problem with deep veins include swelling of your legs, ulcers, chronic skin infections and skin changes in the region of the ankles. Treatment of problems with your deep veins should precede sclerosing of spider veins. Dr. Capella may refer you to a vascular specialist for a deep vein problem.

Dr. Capella will describe the technique of sclerotherapy to you in detail and make suggestions as to the number of sessions needed. Photographs will be taken of the areas of spider veins to be treated. Informational material will be provided and a list of medications not to be taken prior to the procedure will be given.

Sclerotherapy Pre-Treatment Visit
Cleanse your legs with an antibacterial soap such as Dove or Lever 2000 on the day of the procedure. Bring prescribed support hose to the office on the day of the procedure. Otherwise Dr. Capella's staff will provide you with an ACE wrap. Apply vitamin K cream twice a day 3 days before and after the procedure to indicated areas. (Optional) Discontinue alcohol and anticoagulant medications 48 hours before the procedure. Eat a light meal before coming to Dr. Capella's office. Be prepared to remain in Dr. Capella's office for at least 15 minutes after the first procedure. A gown will be provided to you at the time of the procedure. Bring loose fitting clothing and comfortable shoes to be worn after the procedure.

Day Of Sclerotherapy Procedure
You will be asked to change into a gown. With you lying in a comfortable position, Dr. Capella will mark the areas to be treated. After wiping the skin with alcohol, Dr. Capella will begin injecting each vein. The length of the procedure depends entirely on the number of veins to be treated. In general it will take from 15 minutes to 1 hour. Dr. Capella will apply a cotton ball and tape to the areas treated. Following that you will put on your elastic stockings or Dr. Capella's staff will assist you with an ACE wrap. You will then be asked to walk around the office for 10-15 minutes.

Sclerotherapy Post-Operative Care
Maintain normal activities immediately after the procedure. You are encouraged to walk as much as possible and avoid standing in a single position for prolonged periods of time. The taped compression pads are to be gently removed the day after the sclerotherapy procedure. The compression garment or ACE wrap should then be worn for an additional 48 hours, at all times. Avoid strenuous activities such as running, high impact aerobics, and weight lifting for 72 hours after the sclerotherapy procedure. A plastic shower bag may be used to protect the leg while bathing during the prescribed compression interval. If any unusual postprocedure symptoms occur-- such as persistent pain, unusual diffuse bruising, or skin breakdown--call the office immediately. Avoid blood-thinning medications such as aspirin and other non-steroidal anti-inflammatory drugs, dipyridamole, warfarin, and heparin for 24 hours after the sclerotherapy procedure. Consult your internist prior to this change in medications if you have been placed on them for medical conditions.
 
Risks Associated With Sclerotherapy
The most common side affects experienced with sclerotherapy treatment are as follows:
· Bruising: Occurs in treated areas and lasts from one to several weeks. It may occur in association with tenderness and firmness of the treated vein. Use of prescribed support hose and utilization of Vitamin K cream for 72 hours before and after each treatment session along with avoidance of alcohol and anticoagulant medications for 72 hours prior to each treatment session may minimize this effect.

· Transient hyperpigmentation: Approximately 30% of patients who undergo sclerotherapy notice a discoloration of light brown streaks after treatment. In almost every patient, the veins become darker immediately after the procedure. In rare instances, this darkening of the vein may persist for four to twelve months.

· Sloughing: Sloughing occurs in less that 3% if patients who receive sclerotherapy. Sloughing consists of a small ulceration at the injection site that heals slowly. A blister may form, open, and become ulcerated. The scar that follows should return to a normal color.

· Allergic reactions: Very rarely, a patient may have an allergic reaction to the sclerosing agent used. The risk of an allergic reaction is greater in patients who have a history of allergies.

· Pain: A few patients may experience moderate to severe pain and some bruising, usually at the site of the injection. The veins may be tender to the touch after treatment, and an uncomfortable sensation may run along the vein route. This pain is usually temporary, in most cases lasting from 1 to 7 days at most.

· Blood accumulation in the treated vessel: May present as a tender bump at a treatment site. If this develops, it can be simply drained by notifying the physician. The use of prescribed compression hosiery will minimize this possibility.

Some of the other side effects include a burning sensation during injection of some solutions and neovascularization (the development, usually temporary, of new tiny blood vessel); transient, phlebitic-type reactions (swelling of the vein might cause the ankles to swell); temporary superficial blebs or wheals (similar to hives); and, very rarely, wound infection, poor healing, or scarring.

Phlebitis is a very rare complication, seen in approximately 1 of every 1,000 patients treated for varicose veins greater than 3-4 mm in diameter. The dangers of phlebitis include the possibility of pulmonary embolus (a blood clot to the lungs) and post phlebitis syndrome, in which the blood clot is not carried out of the legs, resulting in permanent swelling of the legs.
 
Sclerotherapy Follow-Up Visit
Dr. Capella will ask you to return from 2-4 weeks following the initial procedure. Depending on your progress he will inject the same veins or inject different areas. Once again one to six treatments may needed to treat a certain area.