Spider Veins Sclerotherapy

The spider vein sclerotherapy procedure (synonym: micro-sclerotherapy) is a method of aesthetic medicine. Spider vein sclerotherapy is the targeted sclerotherapy of small-caliber intracutaneous varicose veins. Spider veins are defined as net-like fan-shaped veins running close under the skin, usually located on the thigh. Treatment of these varices is usually for aesthetic reasons. However, in rare cases, spider veins can be painful and are treated for this reason.

Indications (areas of application)

The procedure is primarily used to treat bothersome, cosmetic blemishes. It is an individual decision, which is usually not based on any medical indication

Before the treatment

Before sclerotherapy treatment, the patient should be informed about possible risks and side effects, such as allergic reactions or inflammation. The use of agents that delay blood clotting, such as acetylsalicylic acid (ASA), is not advised. In addition, the patient should refrain from nicotine consumption as early as four weeks before treatment to avoid jeopardizing healing.

The procedure

The aim of sclerotherapy is to obliterate spider veins by damaging the endothelium of the vessels (inner cell layer of the vessels) by injecting the sclerosing agent. This method results in wall thrombus formation (blood clot formation). This is followed by long-term remodeling of the vessel wall into a fibrous (connective tissue) strand (sclerosis). This fibrous strand is not recanalizable (not permeable to blood). The following preparations serve as the most common sclerosing agents:

  • Polidocanol (aethoxysclerol).
  • Polyiodinated ions (varigloban)

The procedure is applied to the patient lying down. A fine sterile cannula is used to puncture the spider veins as centrally as possible at the confluence of multiple varices at a shallow angle. The sclerosant is slowly injected intravascularly (into the vessel). If the cannula is positioned correctly, a drainage of the vessel can be seen. The treatment is largely painless, although a slight burning sensation may be felt. If desired, a local anesthetic (local numbing agent) can be applied. The vessel is then compressed with a swab or plaster. The treatment is completed by applying a compression bandage or putting on compression stockings. During the first treatment, a trial sclerotherapy should be performed to determine any side effects. Here, only a small amount of the sclerosant is applied to the patient. If the patient tolerates the treatment well, the dose can be increased as the treatment progresses. The recommended amount for normal treatment is 0.1 to 0.2 ml of a sclerosant with an active ingredient concentration of 0.25 to 0.5%. Polidocanol in glucose solution (0.2% polidocanol in 70% hypertonic glucose solution) is better at removing small-caliber varicose veins (spider veins) on the legs than 75% hypertonic glucose solution alone (95.17% versus 85.4%; p < 0.001).

After treatment

The compression bandage or stockings should be left in place for two additional days afterward. The first follow-up appointment should occur approximately one week after treatment. The patient must be instructed to avoid sun exposure because of the risk of hyperpigmentation (increased brownish discoloration of the skin) in the area of the wounds. Further notes

  • Endovenous laser treatment/laser ablation and surgical stripping produced more favorable effects on patient quality of life than sclerotherapy over 5 years in a randomized trial. Furthermore, the study demonstrated that complete elimination of the truncal vein was achieved in 75.9% of patients in the surgery group, 64.0% in the laser ablation group, and 33.3% in the sclerotherapy group.

Benefits

Sclerotherapy of spider veins is an effective therapy to make unsightly varicose veins disappear. It represents the procedure of choice for the treatment of spider veins. You benefit by the rapid disappearance of the visually disturbing skin veins and gain a completely new quality of life.