Leg Work by Elvira Maricic Sclerotherapy and other techniques can put an end to suffering in vein print article      send to a friend

Because her varicose veins were large, Oden had a procedure known as surgical ligation, which is performed in the hospital by a vascular surgeon and involves making an incision in the skin and tying off or removing the vein.

Are they dangerous?

Spider veins, which are most commonly found on the legs and face, resemble a purple or red sunburst pattern. Caused by the dilation of a small group of blood vessels close to the surface of the skin, they are unattractive rather than dangerous, and may sometimes produce a dull pain in the legs. Varicose veins, on the other hand, can actually be a health hazard. These blue, sometimes bulging veins are actually engorged blood vessels caused by the weakening of the valves that help push blood back to the heart. Advanced, untreated varicose veins can result in venous statis ulcers, a condition where poor circulation causes the skin to receive insufficient oxygen, bringing about an ulcer; phlebitis, an inflammation of the vein; or thrombosis, a condition where blood clots form in an enlarged vein.

No one knows exactly what causes spider and varicose veins, although heredity, hormonal changes, and pregnancy seem to contribute to the condition. Oden can attest to the latter. Her two subsequent pregnancies have brought on new varicose and spider veins. "I am considering having the surgery done again," she says, adding, " I would not recommend it for anyone who is planning to have children; I would wait until you're done."

Varicose veins can be a health hazard. These blue, sometimes bulging veins are actually engorged blood vessels caused by the weakening of the valves that help push blood back to the heart.

Depending on the size of her veins, this time Oden might opt for sclerotherapy instead of surgical ligation. In this procedure, a small needle is used to inject an agent called a sclerosant into a vein, destroying its lining. The vein then hardens and is absorbed by the body. The procedure requires multiple sessions, with one to three injections required to treat a vein. Some patients consider the treatment somewhat painful, while others report no pain at all. All patients must wear compression support hose as part of post therapy treatment, ranging from three days for small veins to up to three weeks for larger ones. The cost of the procedure depends on the amount of time required to treat the veins, and may be covered by insurance when done for medical reasons.

Sclerotherapy side effects include discoloration of the skin along the treated vein, swelling, bruising, itching, redness, and soreness. And, after all that, there is no guarantee that new spider and varicose veins won't develop.

New options

While sclerotherapy remains the gold standard for treatment of leg veins, there are new techniques, including lasers and light devices, that address the varicose vein problem.

At the recent annual meeting of the American Academy of Dermatology, Dr. Margaret Weiss, assistant professor of dermatology at Johns Hopkins University School of Medicine, described recent improvements that permit successful treatment of spider and varicose leg veins.

One of these, a procedure called the Closure technique, is a minimally invasive, office-based alternative to stripping that is gaining recognition as a highly safe and effective method to treat serious varicose veins. This approach involves inserting a small tube called a catheter into the damaged vein through a very small puncture. The catheter delivers radiofrequency energy to the vein wall, causing the vein to shrink and seal shut. Once the defective vein is closed, neighboring healthy veins take over to restore normal outflow of venous blood from the legs.

"Patients are very pleased with the Closure technique because it requires only a minor incision and allows them to resume normal activity immediately after the treatment," Dr. Weiss said. "Another advantage of the Closure technique over most invasive procedures, like stripping, is that patients experience minimal bruising and virtually no adverse effects."

Dr. Weiss also discussed improvements that allow laser systems to remove spider veins on the leg. She noted that the newest generation of lasers uses longer wavelengths just beyond visible light to better penetrate the skin and reach the veins in the leg, which are more deeply situated than on the face. "The shift to longer wavelengths also helps protect the epidermis because it bypasses the melanin or pigment at the surface, thereby reducing the risk of burning or injury to the skin," noted Dr. Weiss. "This is a major benefit for dark-skinned patients who can now be treated without the hyperpigmentation and skin discoloration associated with traditional lasers," she added. In addition, the near infrared wavelengths and longer pulse durations allow more energy to be delivered to the veins, making treatment more effective with fewer side effects.

"By applying all of these advancements, we can offer relief to patients who suffer from virtually all vein conditions, and greatly improve their quality of life," Dr. Weiss concluded.