Type of Surgery
Information
Last updated: 11/24/2009
Diagnosis
The most important aspect of diagnosis prior to undergoing sclerotherapy is distinguishing between telangiectasias and large varicose veins, and telangiectasias and spider nevi. Because sclerotherapy is intended to treat only...
small superficial veins, the doctor must confirm that the patient does not have a more serious venous disorder.
Spider nevi, which are also called "spider angiomas," are small, benign reddish lesions that consist of a central arteriole, which is a very small branch of an artery with smaller vessels radiating from it. Although the names are similar, spider nevi occur in the part of the circulatory system that carries blood (away) from the heart, whereas spider veins occur in the venous system that returns blood to the heart. To distinguish between the two, the doctor will press gently on the spot in the center of the network. A spider nevus will blanch, or lose its reddish color, when the central arteriole is compressed. When the doctor releases the pressure, the color will return. Spider veins are not affected by compression in this way. In addition, spider nevi occur most frequently in children and pregnant women, rather than in older adults. They are treated by laser therapy or electrodesiccation, rather than by sclerotherapy.
After taking the patient's medical history, the doctor examines the patient from the waist down, both to note the location of spider veins and to palpate (touch with gentle pressure) them for signs of other venous disorders. Ideally, the examiner will have a small raised platform for the patient to stand on during the examination. The doctor will ask the patient to turn slowly while standing, and will be looking for scars or other signs of trauma, bulges in the skin, areas of discolored skin, or other indications of chronic venous insufficiency. While palpating the legs, the doctor will note areas of unusual warmth or soreness, cysts, and edema (swelling of the soft tissues due to fluid retention). Next, the doctor will percuss certain parts of the legs where the larger veins lie closer to the surface. By gently tapping or thumping on the skin over these areas, the doctor can feel fluid waves in the veins and determine whether further testing for venous insufficiency is required. If the patient has problems related to large varicose veins, these must be treated before sclerotherapy can be performed to eliminate spider veins.
Some conditions and disorders are considered contraindications for sclerotherapy:
- Pregnancy and lactation. Pregnant women are advised to postpone sclerotherapy until at least three months after the baby is born, because some spider veins will fade by themselves after delivery. Nursing mothers should postpone sclerotherapy until the baby is weaned because it is not yet known whether the chemicals used in sclerotherapy may affect the mother's milk.
- Diabetes.
- A history of AIDS, hepatitis, syphilis, or other diseases that are carried in the blood.
- Heart conditions.
- High blood pressure, blood clotting disorders, and other disorders of the circulatory system.
Preparation
Patients are asked to discontinue aspirin or aspirin-related products for a week before sclerotherapy. Further, they are told not to apply any moisturizers, creams, tanning lotions, or sunblock to the legs on the day of the procedure. Patients should bring a pair of shorts to wear during the procedure, as well as compression stockings and a pair of slacks or a long skirt to cover the legs afterwards.
Most practitioners will take photographs of the patient's legs before sclerotherapy to evaluate the effectiveness of treatment. In addition, some insurance companies request pretreatment photographs for documentation purposes.
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Varicose veins are the tortuous veins that are visible just under the surface of the skin. While the condition is not generally medically important, varicose veins are not desirable cosmetically. The narrated animation describes how varicose veins are thought to form.
During sclerotherapy for the treatment of varicose veins, the doctor injects a chemical solution directly into the vein (A and B). The needle travels up the vein, and as it is pulled back, the chemical is released, causing the vein to form fibrous tissue that collapses the inside of it (C). (Illustration by GGS Inc.)
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Other Information
A commonly performed non-surgical treatment for varicose and "spider" leg veins is sclerotherapy. It has been used in the treatment of varicose veins for over 150 years. Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping. Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the greater and short saphenous veins. A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution. A Cochrane Collaboration review concluded sclerotherapy was better than surgery in the short term (1 year) for its treatment success, complication rate and cost, but surgery was better after 5 years, although the research is weak. A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux. Complications of sclerotherapy are rare but can include blood clots and ulceration. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready. There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected.
From http://en.wikipedia.org/wiki/Varicose_veins#Sclerotherapy
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