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Sclerosant Spider Vein Treatment

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima Vein Care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

In this section, I am writing about the treatment of so called spider veins. The medical term is cutaneous telangiectasia, but since everyone calls them spider veins, I will too. We believe that they happen because of a local slight increase in pressure in the small veins of the skin, or because of a slight weakness in the walls of these small veins. The increase in the pressure can occur during pregnancy when the baby’s head is lying on the vena cava, a large vein in the back of the abdomen. During the last part of the pregnancy, the baby’s head can press against this, or against one of the veins that come from the legs. These are called the “illiac” veins and the left one is particularly in a position to be pressed on and so spider veins are a little more common in the left leg. Other conditions that can raise the pressure are incompetent valves in the major veins that I have written about in previous parts of this blog. While pregnancy is limited, the valvular incompetence continues until the vein is treated by one of the methods I have described before.

Again, it can’t be emphasized too much, treatment of spider veins and varicose veins will not be effective if an underlying problem exists and is not found and treated first.

Once the underlying problem is treated, we can proceed with the treatment of the spider veins.

The most effective way to treat spider veins is to inject them with a sclerosant that causes them to become inflamed. Then they are slowly reabsorbed and disappear.

The sclerosant we use is usually polidocanol, but at a reduced concentration from what we use in the larger veins.

The concentration to use is not always obvious. There is some disagreement among experienced phlebologists about this. The standard belief, which I share, is that lower concentrations cause less staining, but also are less effective.

For this reason, when I begin a treatment on a new patient who I have not treated before, I will sometimes do a test injection of a single spider vein to find out if the concentration I have chosen will be effective or not, and to see if that concentration will cause staining or not. I will then see the patient back in 6 weeks to see the result. Some patients find this delay frustrating, but I think that this frustration is better than the frustration of having a treatment not work, or cause staining. If the patient is paying for this treatment herself, I will do the test injection for free.

Again, the best advice I can give you in the treatment of spider veins is: “patience and persistence.”

Once I have established the correct concentration of sclerosant, the real treatment can begin.

I’ll write about that next week.