Sclerotherapy - is a non-surgical technique to treat faulty blood vessels that form commonly on our lower legs and thighs. Though treatments have evolved over-time, sclerotherapy, the act of closing off a vessel with an FDA-approved sclerosing agent, has remained the “gold standard” in treating vascular malformations for over 150 years. Injection sclerotherapy may eliminate the need for an invasive surgical procedure.
Causes of vascular malformations are multifactorial and they can appear anywhere on the body, but are most commonly found on the legs and to a lesser extent the face. Gender is the number one contributing factor to their development, with women being affected 4:1 to men. During pregnancy, changes in hormones cause the walls of our vessels to weaken and become thin. This causes blood to leak out and malformations to form.
Also during pregnancy, there is an increase in blood volume, thus increasing blood pressure and further adding to the stress on these vessels. Lifestyle factors such as prolonged sitting or standing can also increase the tension on the closed valves causing them to fail, leading to vein distention. Other less common factors can potentiate these vascular malformations as well, such as repeat trauma, surgery, environmental damage such as extreme temperatures (saunas, sun, cold weather), chronic topical steroid treatments and retinoid use to name a few.
Following injection your legs will be wrapped and you will be required to abstain from exercise, hot tubs and saunas and wear compression stockings for a prescribed amount of time, typically 1-2 weeks.
BEFORE YOUR TREATMENT:
It is important to discuss with your injector stopping the use of products containing NSAID’s (aspirin, ibuprofen), Fish oils, and Vitamin E. It is also important to consider reduced alcohol consumption in the days preceding your treatment. These may increase your chance of bruising or swelling.
The treatment itself involves several injections of a sclerosing agent directly into these leaky vessels. It is a mildly painful procedure and patients can return to normal daily activities within a few days. You can expect injection site redness, mild swelling, and skin discoloration and bruising. Patience is a prerequisite for the procedure, as the process can require several treatment sessions. Veins will not immediately look better, and they will often appear to be worse initially post-treatment. After your treatment, you will be obligated to wear compression bandages or stockings for 1-2 weeks to aid in circulation. A short period of elevation may be required, but afterwards the patient should use regular walks or exercise to help promote vascular flow.
Blood clots and scabs will form on the inside of the treated vessel as a result of the procedure. These clots and scabs sometimes present themselves as bumps under the skin making the vessels appear darker or worse and then eventually tenderness and discoloration disappear as the body works to break them down. This process can take up to 8 weeks.
This technique is much safer than surgical alternatives. Complications are rare in the hands of an experienced vein care specialist. Some side effects as a result of the injection are discoloration of the vein under the skin, bruising or inflammation at the injection site, and allergic reactions from ingredients in the solution. Matting can also occur, which is a phenomenon where your body forms lots of tiny blood vessels around the injection site. Matting will usually resolve on its own but sometimes requires additional injections to relieve.
- Burning/stinging/itching at the injection sites; and or muscle cramps, which usually go away within 15-30 minutes. Swelling of the injection sites or of the feet or ankles may occur. This generally resolves in a few days.
- Areas of increased pigmentation (brown staining) may occur as a treated vein dissolves. This is usually due to iron depositing into the skin. Fortunately, pigmentation usually fades over a period of several months. However, this discoloration may remain permanent in a small percentage of cases.
- "Matting" is an overgrowth of fine caliber red veins near the areas of injection. This may occur in up to 30% of patients, however, most go away with time or with further sclerotherapy.
- Formation of small "burns" or ulcers, usually due to leakage of the chemical solution into the skin. These are more common when hyptertonic saline is used for the injection. They heal in time, but often leave a scar.
- Bruising is common and usually fades away within a week or two.
- Allergic reactions (e.g. rashes). These are very uncommon and usually self-limited. Rarely they can cause serious reactions.
- Inflamed vein (phlebitis). This may be treated with non-steroidal anti-inflammatory medication like Ibuprofen (Advil), walking and compression stockings or bandages.
- Tender, firm bump(s) - "trapped blood." These are areas of treated veins that have closed like a "chain of pearls." Draining the contents helps to seal the vein shut and may reduce the chance for brown discoloration.
Laser Sclerotherapy/Telangiectasia Removal
The 1064 Nd Yag Laser is superior to other lasers because it allows the precise treatment of visible blood vessels, broken capillaries, spider veins, vascular lesions and discolorations of the skin.
The 1064 Nd Yag Laser uses a wavelength of light to harmlessly penetrate the top layer of the skin. It targets the dilated blood vessels beneath the skin’s surface, breaking them apart to be naturally absorbed by the body. It also seals the leaky blood vessel.
During the procedure, the laser’s chilled tip protects the superficial layers of the skin from heat damage and the cooling effect reduces discomfort. Because the laser emits light in a series of pulses, some patients describe the experience as a mild to moderate stinging sensation that feels a lot like a rubber band snapping against the skin. The laser can be easily adjusted to be appropriate for your specific skin type.
Following this procedure, you may notice a bruise-like discoloration for 3 to 4 days. You can expect it to fade to a pinkish or beige color, with complete skin clearing in 6 weeks to 6 months.
The number and length of treatments required will depend on the size, location and depth of the veins needing treatment.
Most cherry angiomas can be removed with the 1064 Nd Yag Laser in 1 treatment.
Cynosure’s ND:Yag laser treatments deliver a precise dosage of energy to each vein to coagulate and close off the vessel. During your treatment, the energy is delivered through a special laser hand-piece to the targeted vein, in a series of brief pulses. The vessel then dies and which is subsequently absorbed by your body. This energy is then absorbed by the blood vessels, but not the surrounding tissue.
These simple treatments effectively treat both spider veins and varicose veins. Spider veins, or telangiectasias, are those small red, blue and purple blood vessels that appear most frequently on the face and thighs. Varicose veins are usually larger than 1/4 inch in diameter and may appear raised with a bluish color. They may also be related to more serious vein disorders and require a careful evaluation by your provider prior to treatment. These options will be discussed with you during your consultation.