Spider veins

Spider Veins

Patient Information: Treatment of Spider Veins (Telangiectasias) with Sclerotherapy

What are Spider Veins?

(medical term: telangiectasias) are small, visible, red, blue, or purple blood vessels located just beneath the skin's surface, often on the legs. They typically have a branched, web-like appearance. They are rarely medically dangerous but are often perceived as cosmetically bothersome.

The causes are often hereditary, but they can also be provoked by hormonal changes (e.g., pregnancy), prolonged standing, or underlying varicose veins. If you have larger varicose veins, it is often recommended to treat them first, as this can reduce pressure and the risk of new spider veins.

What is Sclerotherapy?

Sclerotherapy is a simple and minimally invasive injection treatment used to close and eliminate spider veins and smaller varicose veins.

• Treatment: Using a very thin needle, a sclerosing agent (most often Polidocanol, known as Aethoxysklerol) is injected directly into the vessel.
• Mechanism of Action: The agent irritates the vessel wall, causing the vessel to contract, close (sclerose), and transform into a fibrous cord. The body then naturally breaks down and absorbs the vessel over time, similar to a bruise.
• Foam vs. Liquid Sclerotherapy:
  • Liquid sclerotherapy (microsclerotherapy) is typically used for the finest, smallest spider veins.
  • Foam sclerotherapy involves mixing the sclerosing agent with air or gas (often in a 1:4 ratio) to form a foam. This foam has a larger surface area and better contact with the vessel wall, making it more effective for treating slightly larger spider veins and reticular veins.

The results of the treatment are not immediately visible. Treated vessels typically become darker immediately after treatment (due to solidified blood), and the full effect can only be assessed after 2-6 months.

Before Treatment

To achieve the best effect and reduce the risk of side effects, please consider the following:

• Medication: Inform your doctor about all medications you are taking. In some cases, you may be asked to pause blood-thinning medications (e.g., NSAIDs, aspirin, fish oil) for 3-4 days before treatment.
• Skin: Do not use cream or body lotion on your legs on the day of treatment. Avoid sunbathing or tanning beds for at least 30 days before treatment, as tanned skin makes it more difficult to see and treat the vessels and increases the risk of pigmentation changes.
• Compression Stocking: You must purchase a compression stocking yourself (class I or II, with a pressure of over 24-32 mmHg). This must be brought with you and put on immediately after treatment.
• Important: Sclerotherapy is not performed during pregnancy or breastfeeding.

After Treatment - The Subsequent Course

It is crucial to follow the post-treatment instructions to ensure the best results and minimize complications.

1. Compression (Compression Stocking)

• Wearing the stocking: Immediately after treatment, you must put on your compression stocking.
• Duration: Guidelines vary, but generally, it is recommended to wear the stocking continuously for the first 2 days (also at night) and then during daytime hours for a total of 14 days after treatment. The stocking is essential to keep the treated vessels closed and reduce the risk of blood clots and pigmentation changes.

2. Activity

• Walking: you may take a walk of about 15-30 minutes immediately after treatment.
• Physical activity: you should preferably avoid strenuous, intensive exercise for the first 3 days. However, regular walking, cycling, and light activity are good for blood circulation.
• Heat: Avoid hot tubs, saunas, steam baths, and very hot baths for about 5-7 days to prevent the skin's vessels from dilating.

3. Sun Protection

• UV radiation: Avoid direct sunlight and tanning beds on the treated area for at least 6 weeks after treatment.
• Sunscreen: Apply sunscreen with a high factor (SPF $\ge 30$ or $\ge 50$) several times daily if you are exposed to the sun. The sun increases the risk of lasting pigmentation changes (browning) in the treated areas.

4. Expected Reactions and Side Effects

It is normal to experience the following in the treated area:

Symptom

Description

Duration

Redness and Swelling

The skin may be slightly red and swollen at the injection sites.

Typically disappears within a few hours to a couple of days.

Itching and Stinging

A slight itch or sting may occur when the agent is injected.

Briefly during and after treatment.

Bruising (Hematomas)

Common around the injection sites.

Subsides within a couple of weeks.

Dark streaks/lumps

The treated vessels become dark, hard streaks/lumps due to solidified blood.

Gradually subsides over weeks to months.

Pigmentation Changes

Brownish discoloration (hyperpigmentation) of the skin is seen in some patients, especially if sunbathing too early.

May disappear over months, but in rare cases can be permanent.

Matting (Neovascularization)

Formation of a very fine, branched network of new, small vessels around the treated area.

Seen in some, but is often temporary or can be treated at the next session.

5. Complications (Rare)

• Superficial thrombophlebitis: Redness, tenderness, and swelling along the treated vessel. Contact the clinic in case of severe pain.
• Ulcers: Rarely seen and typically due to the agent leaking outside the vessel.
• Deep Vein Thrombosis (DVT): Very rare but serious complication. Occurs more often if larger veins are treated. Symptoms are sudden swelling, warmth, and pain throughout the leg. Seek immediate medical attention or emergency room if suspected.
• Allergic reaction: Rare but possible to the sclerosing agent.

Expected Result and Follow-up

• Effectiveness: Sclerotherapy typically reduces the visibility of spider veins by 70-80%.
• Number of treatments: It is individual, but often 2-4 treatments with an interval of 4-6 weeks are necessary for a satisfactory result.
• Durability: The vessels that have been treated and closed rarely reappear. However, new spider veins may develop over time, especially if you are genetically predisposed. Repeated treatments may be necessary every few years.