How are unwanted blood vessels on the legs treated?

In the majority of cases, a procedure called sclerotherapy is used to treat unwanted blood vessels.  One of several kinds of solutions called sclerosing solution, is injected with a very fine needle directly into the blood vessel.  This procedure has been used for spider veins since 1930s and before that for larger veins.  The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to clot.  Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable or visible.

A single blood vessel may have to be injected more than once, some weeks apart, depending on its size.  In any one treatment session a number of vessels can be injected.  Occasionally larger varicose veins are underneath the spider veins.  In such cases, some physicians believe these vessels should be treated before the spider veins.  This can be done by sclerotherapy followed by compression or by a surgical procedure performed by a vascular surgeon.  Other physicians believe that spider veins may be treated by sclerotherapy without worrying about the varicose veins unless they become troublesome.

How successful is sclerotherapy?

After several treatments, most patients can expect a 50% to 90% improvement.  However, fading is gradual.  Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.

Can sclerotherapy be used on all skin types?

Yes, all skin types and skin colors respond equally well.

Are there side effects to sclerotherapy?

Even with a highly experienced physician performing the treatment, there are some possible side effects.  They include

Stinging or pain at the sites of injection, swelling of the ankles or feet or muscle cramps.  Muscle cramps almost always occur when the injection takes place in the ankle area.  These usually go away with 10 to 15 minutes after injection.

Red, raised areas at the sites of injection.  These should disappear within a day or so.

Brown lines or spots on the skin at the sites of treated blood vessels.  Probably made up of a form or iron in the blood, these darkened areas may result when blood escapes from treated veins.  These dark areas occur more often in patients who have larger veins treated.  In most cases, they disappear within a year, but in a small percent of patients they may last longer.

Development of groups of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs.  About a third of patients develop these; most disappear by themselves, some go away with injection treatment or laser therapy, a few may last.

Small, painful ulcers at treatment sites either immediately or within a few days of injection.  These occur when some of the solution escapes into the surrounding skin.  These can be successfully treated, but it is necessary to inform the physician of them immediately.

Bruises at the site where the needle went into the skin.  These will disappear in a few weeks and are probably related to the thinness of blood vessel walls.

Allergic reactions to certain sclerosing solutions.  Although such reactions can be serious, and require immediate injections of epinephrine.  Less serious reactions are treated with antihistamines.

Inflammation of treated blood vessels.  This is very unusual but when it occurs it is treated with medications such as aspitin, compression, antibiotics or heat.

Lumps in injected vessels, particularly larger ones, may develop.  This is coagulated blood but is not dangerous.  The dermatologist may drain the blood out of these areas a few weeks after injection.

Blood clots may occur. 

Will treated veins recur?

Larger veins are likely to recur unless support hose are worn.  Spider veins may also recur.  It may seem that a previously injected vessel has recurred, when, in fact, a new spider vein has appeared in the same area.

The above information was from a brochure entitled "Spider Vein, Varicose Vein Therapy" from the American Board of Dermatology