Sclerotherapy: Vein Treatments
What is sclerotherapy?
Sclerotherapy is a non-surgical procedure that can treat most diseased surface veins. Medication is injected into a vein using a small needle. The medication irritates the vein walls so that they stick together and are gradually reabsorbed by the body. Eliminating these diseased veins actually improves the circulation and makes the legs healthier.
What will happen in the first consultation?
You will be asked questions regarding your past health, medication history and symptoms. A doppler exam may be performed and the nurse practitioner will examine your legs. You will have an opportunity to discuss the treatment and ask any questions. If the veins are small, flat “spider veins”, then treatment can often begin on the first day.
What causes vein problems?
Veins carry blood from the legs back to the heart through one-way valve systems. When there is a weakness in the vein wall or a faulty valve, the valve stretches and no longer closes properly. The veins become filled with blood that can’t flow normally, causing pain, swelling, discoloration, sores that won’t heal, blood clots and other problems.
What types of vein problems does First Impressions Medical Aesthetics & Rejuvenation Clinic treat
Spider veins and reticular veins are the most common. Other vein problems include chronically swollen legs, recurrent infections, thrombophlebitis, and pregnancy-related problems.
How many treatments are required?
Depending on the type and severity of the varicose veins, the average number of treatments is anywhere between 3 and 5, however as many as 10 treatments may be required. The larger vessels only require a few (3 or 4) well placed needles with a stronger solution. They must be treated first through a referral process. The smaller spider and reticular veins may require many points of injection with a weaker solution. The injections will be stopped at any time if the patient so requests. The number of injections is less important that the type of sclerosing agent used, its dosage, the site of the injections and the skill of the nurse practitioner and her staff.
Why First Impressions Clinic?
D. Hart NP has been trained in reticular, spider and varicose vein treatments and recognition of advanced varicosities by internationally renowned Dr Deborah Martin, a recognized physician & international sclerotherapy instructor. D.Hart NP has been practicing in the healthcare field for more than 20 years, is a licensed professional in the provision of vein treatment and is dedicated to all her patients and assisting them to achieve their ‘best self’.
Diagnosis & Treatment
Diagnosis starts with a careful history and physical exam. Diagnostic tests are often needed to evaluate the extent of disease. If treatment is indicated, each one takes about 20 minutes. The number of treatments depends on the severity of the problem.
Discomfort after treatment is rare. Most patients finish their procedure and go directly back to work. We recommend that patients walk for 20 minutes after each treatment.
Is there Insurance Coverage ?
The diagnosis and treatment of significant problems due to large diseased veins are sometimes covered by MSI. Spider and reticular veins are considered “cosmetic” and therefore do not qualify for most insurance plans. The compression stockings that are recommended are often included in private medical insurance plans.
What are the most common side effects?
All medical treatments entail a certain degree of risk. This will be discussed during your first visit and consent to treatment must be signed before the injections are started. Fortunately, when injections are undertaken by well trained professionals, complications rarely arise.
Spider & Reticular Veins:
In the first few days itching, bruising, aching, redness and swelling are common. Most of these symptoms resolve spontaneously. You may take Tylenol (acetaminophen), but do not take ASA (unless for the treatment of heart disease) or related compounds (aspirin, naproxen, and ibuprofen) since they may increase bleeding. It may help to elevate the legs and rotate the ankles. Some patients (particularly those with fair skin) notice small red circles or brown lines after treatments. These are due to the pigment of blood or inflammation and usually resolve within 1 month. Ninety percent of the discolorations resolve with 1 year. A superficial blood clot may develop at the injection site which causes a lump. This will disappear in 2-8 weeks. A small superficial ulceration of the skin overlying the injected vessel may occur. It can leave a small scar. “Matting” refers to the development of new tiny blood vessels in the treated vessel. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 18% of women receiving estrogen therapy (for menopause) and 2 to 4 % of all patients. You will be monitored at the clinic for an allergic reaction (very rare) which can include hives, shortness of breath and swelling around the airway. If this occurs at home, seek medical attention immediately.
In addition to the side effects listed above there are several complications which are unique to varicose vein treatment. Phlebitis may develop at the site of injection as a firm nodule. This resolves with elevation of the legs, application of a cool pack, rotation of the ankles, tensor bandage and aspirin for 48 hours after treatment. Deep Venous Thrombosis (DVT) is a very rare complication, seen in approximately 1 out of every 30,000 patients treated for varicose veins greater that 3 to 4 mm in diameter. DVT will be recognized by pain and swelling of the entire foot. The possible dangers of DVT include the possibility of a pulmonary (lung) clot and post phlebitic syndrome, in which the blood clot is not carried out of the legs, resulting in a permanent swelling of the legs. If the sclerotherapy solution becomes lodged in an artery instead of a vein, its occlusion may cause an interruption of the blood supply to an area outside of the limb.
What should I do before a treatment?
Do not take aspirin, ibuprofen or other arthritis medicine for 2 days before and after you treatment because these medications can increase bruising. Do not drink alcoholic beverages or smoke for 2 days before and after your treatment. They may impair healing. Shower and wash your legs thoroughly with an antibacterial soap. Do not shave your legs the day of your appointment. Do not apply any cream or lotion to your legs, including tanning cream. Bring loose fitting shorts to wear during the treatment. Eat a light meal or snack 1 – 1½ hours before your appointment. If you sometimes get lightheaded during medical procedures, consider bringing someone to drive you home.
What should I do after a treatment?
Spider & Reticular Veins – Your legs will be covered in cotton balls attached with tape, so you are advised to wear dark colored loose fitting clothing to the session. Remove the cotton balls after one hour. Resume normal activities. Avoid alcohol, ASA, and hot baths for 48 hours.
Varicose Veins – If the veins are large, you will be advised to wear your compression stocking for 48 hours. Walk or keep active for a half hour after the session to maximize results. Bring comfortable walking shoes. If traveling more that 30 minutes to the office, have someone drive you so that you can move your feet and legs as the passenger. Avoid tanning until the end of treatment and all the bruises have disappeared, otherwise you tan colour may be irregular. Do not use self tanning lotions for at least one month (it can cause unsightly streaking). Maintain normal activities but avoid strenuous physical activities such as high-impact aerobics or weight lifting for at least the first 48 hours. Ask your physician if you routinely exercise heavily, such as running. Avoid prolonged standing and hot baths for 1 week. Cool your legs with cold water after each shower. Most people can return to work immediately after a treatment. Do not sit in a “hot tub” for 4 weeks after treatment.
What can I do to prevent varicose veins from coming back after a treatment?
Varicose veins are a chronic illness and are subject to recurrence. First Impressions Medical Aesthetics & Rejuvenation Clinic uses the most current methods to effectively treat visible veins and try to prevent future veins from appearing. In addition, there are several steps that you can take in order to assist your own care:
1. Compression stockings are highly recommended and come in a variety of colors and styles. Use them when you legs ache, for long trips or for prolonged walking or standing. D. Hart NP will prescribe the correct strength and size for you. They increase the effectiveness of treatment by 50% and help to prevent recurrences.
2. Wear comfortable shoes with a 1 – 2 inch heel (running shoes are best).
3. Avoid wearing girdles and ordinary knee high stockings (they impede circulation)
4. Exercise regularly. Avoid standing for long periods and if you do, flex your muscles or sit/lie down with your legs up. We have a handout on exercises.
How to get more information
Please feel free to contact us at any time. We have brochures, patient education literature, articles and many other resources we’d be glad to share with you.