Overview

Spider veins, also called telangiectasias, are tiny visible vessels just underneath the skin. They develop most commonly on the face and legs. Varicose veins are distended veins beneath the skin. They may appear as bluish bumps and often cause discomfort. Those with unsightly varicose veins and aching pain often choose to have surgery to remove their varicose veins. Varicose veins are veins that are no longer functional, and their presence is not missed by the body. Ask your cosmetic surgeon about varicose vein treatment. If you have both varicose and spider veins, your varicose veins must be treated first. Treating spider veins first is generally futile because, in the presence of varicose.

Varicose veins are classified into 3 major groups

  • Varicosity of the Long Saphenous Vein.
  • Varicosity of the Short Saphenous Vein.
  • A third group of atypical Varicose Veins occur in a small group of people.

The deep and superficial veins of the legs

The veins of the legs are divided into two systems – the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see on your foot or around the ankle and they are the ones that can become varicose veins.

Perforators

In a number of places in the leg, the superficial and deep veins are linked by perforating veins ('perforators'). They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. Normally their valves should allow blood to flow only inwards – from the superficial veins to the deep veins. If the valves stop working properly, then blood is pushed out into the superficial veins when the muscles contract: this is one of the reasons for high pressure in the superficial veins, and can be a cause of varicose veins

Valves in the veins

There are delicate valves located at half to one centimeter distance through out the length of veins which helps to pump the venous blood towards the heart against the gravitational force just like the 'Foot Valve' of the water pump. They are unidirectional valves which prevent the back flow. The incompetence of these valves is the basic pathology of varicose veins.

The muscle pump

The Calf muscle acts as the booster central pump to lift forcibly the venous blood from the Deep Veins to the heart. (Peripheral Heart)

What are the predisposing factors?

Age : As age advances the frequency of the disease increases
Sex : Most commonly seen the female population
Racial Hereditary Factors :
Hormonal : Female hormone
Pregnancy : Pressure of gravid uterus on the major veins in the abdomen
Secondary to Diseases: : Fibroid Uterus, Lower abdominal tumors
Secondary to Deep Vein Thrombosis Chronic Constipation :
Occupational : Standing for long standing

Symptoms

Pain : Dull aching pain in the lower leg is the commonest early symptom
Swelling of the feet : Oedema of the feet especially on standing for long time or by evening is the next common sign
Bleeding Itching :
Discoloration :
Blackish discoloration around the ankle joints and lower leg Eczematous Change around the ankle and foot
Hyperlipodermatosclerosis : Thickening of the skin with depigmentation or hyper pigmentation
Ulcer Formation : Initially small ulcers develop and heal spontaneously over a period of time
Giant Ulcers :
Later small ulcers refuse to heal and proceed to progressive skin erosion resulting in very large non healing ulcers Investigations In addition to the routine investigations, the specific investigation is a Color Doppler Scan of the Lower Limb Venous System. The main purpose is to rule out any thrombosis Clotting of blood) in the Deep Vein.

Treatment Choices for Spider Veins of the

  • Minimally Invasive Procedures
  • Electrodesiccation: This is the process of passing electric current through a probe to ......destroy the vessel wall.
  • Radiofrequency ablation
  • Endo venous Laser Ablation (ELT)
  • Sclerotherapy: Sclerotherapy /Foam Sclerotherapy, the oldest, simplest and the cheapest method of treating varicose veins, the most accepted and promising method of treatment by constant innovations in the technique. It takes hardly 10 to 15 minutes for the completion of the procedure.

FAQ's

  • What is Sclerotherapy? In all minimally invasive procedures, the principle involved is basically the same. In electro desiccation a wave of electric current is used to destroy the inner lining of the vessel wall. In Radiofrequency it is again the radiofrequency waves that are modulating the destruction process by mechanical damage. In Laser therapy (ELT) laser beam administered through a special probe produces thermal burns on the vessel wall, Likewise in Sclerotherapy a chemical substance that is injected at selected sites produces chemical burns.
  • How does the Sclerosant Act? The Sclerosant produces chemical burns of the endothelium, Due to the severe inflammation of the vessel will the vessel wall will stick together and get fibrosed.
    About Sclerotherapy

    Phenol in almond oil injected through a special cannula was the original method of Sclerotherapy. This is no more used. The sclerosing agents currently used are Sodium Tetradecyl Sulfate (STS), Polidocanol (POL) and Ethanolamine. Method of administration and the strength/dilution of the sclerosant depends on the size of vein, the site injection and above all the experience of the surgeon. The solution is injected at multiple sites in varying dilutions. No anesthesia is required. No hospital stay is usually required Pain at injection site is variable . In smaller veins there will be some pain but in larger veins it is practically painless. If the drug extravasates, there is will excruciating pain and subsequent tissue necrosis will develop. The procedure has to be done by a Surgeon well experienced in the technique. There should be all facilities to combat any untoward reactions of the drug,, though extremely rare. Crepe bandage is applied over the injected sites., assuring compression of veins. The patient can walk about after the procedure. In fact, they should be encouraged to walk about following surgery. In rare occasions, two or more sittings may be required to effect complete occlusion of the vessels. Revascularization and recanalisation of the veins contribute to recurrence. The Newer technique is the Foam Sclerotherapy, which has got added benefits over the conventional Sclerotherapy. The overall cure rate is more than 90% in all available literature. The success rate in operative procedure is limited to 80%.

    In what all conditions Sclerotherapy is advocated. In all stages of the disease Sclerotherapy can be done. In some literature it is stated to be good only in smaller size veins and midsized veins. The statement is absolutely wrong; it is very effective in large sized veins as well. This can be done in cases of recurrence after surgery In patients who are otherwise unfit for surgical procedure
  • Where not to be done?
    • If there is Deep Vein Thrombosis
    • If the patient is allergic/sensitive to the drug
    • In pregnant and lactating women
  • What are the precautions after the procedure? The procedure is done preferably on one limb at a time. After the injection the patient can go home and take rest. To avoid swelling of the limbs, it is preferable to keep the limb elevated It is also advisable to use crepe bandage to the limb for at least 10 days to help the veins remain collapsed and stick together.

Additional Information

Advantages

  • Very safe procedure
  • Very Simple
  • Economical
  • Enhanced success rate over other procedures
  • No hospital stay
  • Can go back to normal activities earlier than all other techniques
  • Safe for very aged patients otherwise unfit for surgery
  • Extremely very rare chance of Deep Vein Thrombosis

Disadvantages

  • Allergic/ Hypersensitivity reactions
  • Recurrence of new Varices or recanalisation
  • Local reactions, tissue necrosis, itching
  • Extremely very rare chance of Deep Vein Thrombosis

Laser treatment of spider veins

During laser treatment, a laser is applied to the skin over your spider veins. Laser energy causes your spider veins to coagulate and shrink. Laser therapy is most effective for small and medium size spider veins. Large spider veins respond poorly and are best treated with sclerotherapy. You are likely to experience mild discomfort similar to having a small rubber band snapping against skin. Treatments usually do not require sedatives, pain medications, or injections of local anesthetic.

Immediately following treatment, spider veins will be darker and more visible. Over two to six weeks, your spider veins usually fade. After each treatment, you will see a 70% to 80% improvement in the appearance of face spider veins and 30-40% improvement in leg spider veins. An average of three treatments will be required at three-month intervals to produce desired results. Combination therapy can be considered and beneficial if you have small, medium and large spider veins. You may wish to start with sclerotherapy, because sometimes all veins will be improved after injecting the larger ones. This may reduce the number of veins that need to be treated by laser and minimize your overall cost.

Spider Veins of the Face

A patient with spider veins in the face will usually choose to have laser therapy rather than sclerotherapy. Laser treatment may cause minor bruising that usually improves within a week, but often, recovery is immediate. Two to four treatments may be required to achieve your desired result. Immediately following treatment, you may apply makeup for a presentable appearance.

Potential Complications:

  • Matting
  • Discoloration
  • Skin necrosis
  • Swelling

Cost

Sclerotherapy costs between Rs.2000-15 per session. Laser treatment costs Rs.2000-12000 per session. Expect to pay more if your spider veins are extensive or if a physician rather than a supervised technician performs the treatments.

Expected Duration of Results

Regardless of treatment, you should anticipate the development of new spider veins over time, just as you would if your spider veins had not been treated. Spider vein therapy treats current spider veins but does not prevent new ones.