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What are Spider Veins?
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Spider veins appear to be hormonally induced and are associated with
pregnancy and menstruation. Although these spider veins are not
usually symptomatic, the feeder veins deeper in the skin often cause
discomfort. Many women have a combination of both
varicose and
spider veins. While patients may seek treatment for cosmetic
improvement, many are looking for relief from pain.
Many people assume that all vein treatment is the same no matter
where you get treated. It is the opinion of
Dr. Karlin that
treatment techniques vary greatly. And so do their results. At
VCA
we have definite opinions about the treatment of spider veins
because we have been treating them since 1989. Patients have many
questions; mostly they want to know about "recurrences". Your
chances of recurrence are related to several factors, but most
importantly to the thoroughness of your treatment. This can be
related to physician skills, but it can also be due to the patient
quitting too early. These patients believe their legs look good
enough when, in fact, more work should be done in order to prevent the
growth of new veins. (Whatever remnants of veins are left in the leg
will quickly grow into more veins.)
Spider veins occur
mainly in women, and this is because they are produced or grown by
their female hormones. Men also get small veins but these are
usually high-pressured "blow-outs" from nearby
varicose veins. These
are darker and fatter looking veins rather than the fine burgundy-colored spider variety in women. The difference is important because
the treatment is different. Many women state that their spider veins
are hereditary because they inherited them from their mother who got
them from her mother, and so on. But none of her brothers or uncles
got them even though they shared the same genetic predisposition.
The reason is they lacked the final link in the causal chain: the
female hormone estrogen.
Spider veins grow from "reticular" veins, also known as "feeder"
veins. But these feeders exist in a dense network. They are usually
just a little deeper in the skin. They are a network of blue veins,
or sometimes green in color, which can impart a marbled appearance
in the skin of some patients. They might even be difficult to see in
some women because they are a little too deep in the skin. But they
are there nonetheless and must be eradicated in order to get the
best results possible (and reduce the chances of recurrence). Many
women, not knowing the significance of these, don't want them
treated, thinking they'll save money because those veins are not
ugly enough. But they are a platform for growing more spider veins.
Many doctors use "saline" (a salt solution) to inject into spider
veins. This causes the spider veins to become inflamed and shrivel
(fade away). But saline in the feeder (reticular) veins can cause
severe muscle cramps. Or, the reticular veins may be excluded from
treatment altogether. This can leave you with many reticular veins
to grow another dense crop of spider veins in the near future.
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At
Vein Centers of
America, we don't use saline. We developed a specific dilution of
sodium tetradecyl sulfate (FDA approved) because it is effective on
the reticular veins and doesn't cause muscle cramps. We found that
it works best when used in a particular way.
The medicines used to shrivel your veins (called "sclerosants") have
no "seek ugly vein and destroy it" intelligence (in a manner similar
to antibiotics that pursue and destroy specific bacteria). It is by
skillful placement in a systematic fashion that we can carefully
eliminate your abnormal veins.
Sclerotherapy is a simple and ingenious concept, but its proper
execution is an art that can take years to master. The goal is to
trigger the targeted vein into destroying itself without damaging
the surrounding tissue. If you've ever had soap in your eye while
taking a shower you have experienced an inflammatory response: a red
eye. This is similar to the inflammatory reaction, but in this case
the eye recovers. Fortunately, the vein is vulnerable enough so that
it does not recover. It shrivels and fades away over time. In
sclerotherapy, any more inflammation than is necessary can cause
damage to the surrounding skin. The principle of "minimally
effective damage" (just enough to do the job) should be constantly
considered with each injection. This is especially true if the veins
are of different sizes and are at different depths in the skin.
During treatment, understanding the variables of concentration,
volume and "exposure time" of the solutions are important to
fine-tune the results. We also use externally applied "compression",
if necessary, for its anti-inflammatory action in order to lessen an
exaggerated inflammatory response.
The solution we prefer (sodium tetradecyl sulfate) works by
inflaming the vein wall. The protein of the vein wall, and the blood
(also a protein) inactivates the solution we use. So there is
deactivation at the site of injection, and the impact of the
solution diminishes with distance from the site of the injection.
This reassures you that distant areas of the body will not be
affected by the solution, especially with the dilutions we use.
Varicose veins and spider veins are "out of the circulation" because
their "reflux" converts them into a sort of "cul de sac". This gives
us confidence in the inherent safety of this technique.
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In spite of the best efforts, you can still grow more spider veins
because of the relentless effects of your female hormones,
especially if you get pregnant. To get the best results, however,
you need the best methods available at the outset. Total eradication
of the abnormal reticular veins should be one of the goals.
Some women ask if they should defer treatment until they are
finished having children. The answer depends on your condition. If
your spider vein condition is light, it might be all right to let it go for
a while. However, if you have hundreds of spider veins, they can get
much worse in a hurry. If you get them treated properly, there will
be fewer reticular veins left to grow more spider veins during the
next pregnancy.
Many women are concerned that they might need these veins for their
circulation. Eliminating these abnormal veins can only improve the
circulation. This is because vein disorders are typically a
proliferative condition (i.e., continues to make new veins and
expand). Appropriate treatment trims them back towards normal. Most
women who come in for cosmetic reasons find that their legs feel
better after treatment. They often report that they can now tolerate
standing for prolonged periods of time after their treatment is
complete.
How many treatment sessions you will require depends on the severity
of your condition. We will evaluate you on your first visit and
explain what will have to be done for best results. We will begin by
treating the worst leg and only start your second leg after you are
satisfied with the progress of your first leg.
Side effects and complications are possible as with all medical
procedures. For spider veins the most important side effect is the
potential for damage to the skin from the medication used. This is
where training and experience counts. Damage to the skin is possible
if your skin is overly sensitive to the dilute medicine, or if you
have very dense spider veins, or it you already have damage to your
skin because the veins have deteriorated so much. In these cases the
patients can experience some itching dermatitis (inflammation of the
skin) and pigmentation (brown stains) of their skin. Caution is
usually exercised in treating these cases, but occasionally very
normal-looking skin can break down and leave a small scar in spite
of the best of intentions. Also, the darker the skin, the more
vulnerable it is to inflammatory pigmentation. These cases demand
particular attention to the most fastidious methods, and they might
still pigment. Usually the higher risk patients prefer to go ahead
and try a few non-essential areas as a test site. They may complete
the treatment when they see the results of these test areas. But
there are no certainties in medicine. On the other hand, the longer
you delay treatment the worse it will become, and the more treatment
(and cost) it will take.
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Good sclerotherapy is an art because the challenge is to eradicate
the useless and ugly veins without damaging the surrounding skin.
Obviously this is more difficult and takes more time in the worst
cases. Experienced doctors find that patients who didn't want to
look at their veins before treatment now can't take their eyes off
them once treatment commences. (The more you seek, the more you'll
find. Some patients even bring magnifying glasses with them). This
concerns us because we jokingly comment to patients that "the
medication appears to be improving your eyesight while it
deteriorates your memory". A typical patient comment can be,
"Doctor, I don't remember seeing this vein before". The implication
is that you are growing more veins. You are, but it's nobody's
fault. Didn't I say that this is a proliferative condition,
constantly growing under the influence of your female hormones? Not
to worry! Nobody's counting. We'll treat those new veins anyway.
An allergic reaction is rare for us in treating small veins. I can't
remember a single case of allergy from treating small veins because
the medication is so dilute. That's not to say it is impossible, but
the chances are small. Allergy is more likely in treating the larger
varicose veins where the concentration of the medicine is greater
and the volumes are larger.
You will discover that many of our staff, including the nurses, have
had this treatment not only to their legs but also their hands, face
and even to the veins around their eyes. Some women have dark
circles under their eyes. They are more common as you get older, and
are usually a condition of women. These patients have feeder veins
coming from their scalp that drain into the veins under their eyes
where the blood collects and distends those veins, making their eyes
darker. We can see the feeder veins at the upper front temple
regions. Treatment of these veins can markedly reduce or eliminate
these dark circles. (And no, it doesn't affect your brain, or the
blood circulation to your eyes). Prominent veins are a proliferative
condition here also, and treatment (eradication) is merely reducing
the number of veins towards a more normal level.
Laser. Don't even think of it. Laser is a wonderful tool for some
procedures but not for veins. It damages the skin because of intense
heat, it is a slow method and it hurts like heck. It is good for
vaporizing "static" targets (like warts or steel bars), but is
virtually useless for "dynamic" situations like stopping the blood
flow within abnormal veins. On the other hand, sclerotherapy is an
ideal "concept" but it needs to be constantly adjusted and
manipulated for veins of different sizes. It has the great advantage
of being able to eradicate a nearly invisible (and inaccessible)
network from just one injection. It is the great capacity of
sclerotherapy to get to the invisible components of vein disorders
that separates it from other modalities of treatment. We routinely
see this when we make a dozen small veins disappear from one
well-placed injection. This level of proficiency saves time and
money.
There is no Board Certification yet for this new specialty. And it
is not taught in surgical training programs
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