VARICOSE VEIN TREATMENT

Treatment of varicose veins depends on the size and location, as described below.  Results are usually permanent, although new varicosities may continue to form.  It seems that patients who do continue to form new spider veins come in about every three years for a single visit. 

SPIDER VEINS

Sclerotherapy is performed by injecting either Aethoxysklerol or Sotradecol into the vein to scar it shut..  The smaller spider veins are usually injected with Aethoxysklerol and their feeder veins as well as larger varicosities are injected with Sotradecol.  Aethoxysklerol’s patent expired before it became popular in the United States and as a result no manufacturer wanted to spend the money necessary to obtain FDA approval.  It is used in every country in the world.  I obtain it from Canada. 

Risks of sclerotherapy are mainly adverse cosmetic outcomes-- more people (and not many) bleed to death in their sleep from ruptured varicose veins than die of complications of treating varicose veins.  Adverse cosmetic outcomes include

--Ulceration (dead tissue) in the area of injection.  This heals like a burn.  I have had three cases since 1989.
--Pigmentation (discoloration).  Blood gets trapped in treated veins.  Sometimes there is enough to warrant draining it, so if I give you a return appointment, please return.  The breakdown of the blood can leave first a bruise and then a freckle color  (iron from the brefakdown of hemoglobin in the blood).  Discoloration is rarely permanent, and rarely looks worse than the varicose vein that was there, but it can take two years or so to resolve.  Stay off of iron-containing vitamins until discoloration has resolved, because you want all the iron-transporting protein in the blood to be available to carry iron away from the treatment sites.  Pigmentation is more likely to occur in treatment of veins of the lower leg, probably due to higher pressure.
--Telangiectatic matting (formation of a fine mesh of new blood vessels).  This seems most problematic at the inner knees, but can occur anywhere.  It isn’t predictable.  It looks like a pink or purple patch of skin but on close inspection is many small blood vessels close together.  It can be very hard to treat and makes patients wish they had never had varicose vein treatment.  Fortunately it isn’t that common, especially if one is conservative in treating the inner knees (or uses laser there, because the blood vessels are usually small enough).
--Allergic reactions (itching, asthma, anaphylaxis) have only been reported with Sotradecol, not Aethoxysklerol.  I have not seen one in 20 years, but I am prepared if one occurs.

 

LARGE VARICOSITIES

Some evaluation with Doppler or light-reflection rheography may be necessary before the start of treatment to be sure that the major valve at the top of the leg is working, or that the valves in the deep venous system are working.  If the deep venous system isn’t working right, it may not be advisable to do anything to the superficial system.  If the major valve (sapheno-femoral) isn’t working, foam sclerotherapy of the long saphenous vein using ultrasound guidance may be advised.  Endovenous laser or the VNUS radiofrequency endovenous ablation procedures are the other alternatives.  Stripping is outmoded.

Some fairly large varicosities can be injected, with foam sclerosants being better than liquid for these large vessels.  However, most are better treated by an office procedure called Mueller phlebectomy (developed by Dr. Robert Mueller of Neuchatel, Switzerland around 1980).  This procedure is also referred to as ambulatory phlebectomy, stab phlebectomy, mini-phlebectomy, or micro-phlebectomy.  The vein is anesthetized and punctures are made along it about every 1¼ inches.  Hooks are used to extract the vein in sections.  A compression stocking is applied (actually, the first day, two stockings) to prevent bleeding.  Benefits include less pain, less discoloration, and a guarantee that the varicosity will not return.  The last point is very important, because with large varicosities of the calf the body often manages to open the vessels up again over time. 

 

PREPARATION FOR VARICOSE VEIN TREATMENT

Please do not apply moisturizing cream after the last time you bathe before treatment— it makes it hard for tape to stick to the legs.
If you have some tiny veins, particularly the inside of the knees, I may be using the laser—but I can’t if you have much of a tan. 
Wear long pants to your appointment, preferably dark color in case some blood gets on them.
After sclerotherapy, avoid sitting or standing still the remainder of the day of treatment.  After Mueller phlebectomy, plan on putting your leg(s) up the rest of the day and be prepared to do so the next day also if you start to bleed when you put your leg(s) down.

 

FOLLOW-UP

When veins are treated with injection sclerotherapy, either foam or liquid, you need to return in 3 weeks so that any trapped blood can be let out via needle punctures.  Otherwise the area will become discolored from the iron in the trapped blood.
After Mueller phlebectomy, a return visit is usually scheduled in 8 weeks so that any sections that were missed can be injected with foam or additional phlebectomies performed.

 

THE COST OF VARICOSE VEIN TREATMENT

One to three sessions are typical.  Sclerotherapy and laser begin the first visit—I don’t require a preliminary consultation.  I charge $240 plus $1.50 per flash with the laser, the cost of the sclerosing solutions (usually not over $36 total), and $50 per phlebectomy puncture.   Phlebectomy takes more time than I book for a first visit, so you would just pay the $65 consultation fee, or $130 if Doppler or light reflection rheography were needed, and return for the procedure.  Compression stockings, only needed with phlebectomy, are about $33