SCLEROTHERAPY (Vein Injections)
for TELANGECTASIAS (Spider Veins)
of the LOWER EXTREMITIES
About The Procedure
Telangectasias are small blood vessels in the surface of the skin, scattered throughout the lower legs, or other areas, which are less than 1-2mm. in diameter. Heredity, skin characteristics, activity (sedentary vs. ambulatory), pregnancy, and physiologic fluctuations in hormonal levels all contribute to the visibility, prominence and recurrence of the small vessels pre and post treatment. The primary treatment for lower extremity spider veins consists of injection with a sclerosing agent, which irritates the vessels and causes blood to clot within them. Subsequently the body, with an inflammatory response, dissolves the clot and collapses the vein with scarification of the vessel wall. The overall effectiveness of sclerotherapy for surface telangectasias is about 60-70%. Some of these vessels recannulate and recur over a period of several weeks to months. The whole process of obliteration takes 3-4 months to complete its cycle. In general, there is improvement immediately with less visibility of the vessels. Repeat procedures, when needed, can be undertaken at 4-6 month intervals to address those vessels that have not completely responded or new vessels.
Injection therapy is to some degree self limited, in that the residual vessels become smaller and smaller in diameter and are unable to be cannulated with even the smallest hypodermic needle. These types of vessels are best treated with vascular laser therapy. Some types of leg telangiectasias are best treated by vascular laser initially. Blue vessels, especially on the legs, are best treated with a Yag laser if injection therapy is not appropriate. Facial telangiectasias (fine, red superficial vessels) are best treated with vascular laser versus injection sclerotherapy, as injections into facial vessels are dangerous. Injection therapy and Yag laser treatment for lower extremity spider veins are complementary procedures whose application must be individualized to clinical circumastances and desires.
Risks
Potential risks of this procedure include small areas of skin discoloration or scabbing which may take several weeks to completely resolve. The agents used for sclerotherapy are fairly hypertonic and concentrated and can damage the skin at the injection sites, especially if post operative instructions are not followed, including elevation of the extremities and limitation of activities for the first 12 to 24 hours. There are also times when the minor bruising that is associated with injection therapy can remain for longer periods of time. This has been noted to occur for up to six months. If any significant residual scarring or areas of pigment remain for long periods of time, the option for these would be subsequent excision of the area and suture closure. This is rarely necessary.
Post Treatment
The postoperative instructions should include elevation of the lower extremities as much as possible for the first 12 hours after injection therapy has been completed. Elevation can be lying in bed or raising the legs on a footstool or in a chair. It is also important to utilize heavy support hose that are applied immediately after the injection therapy session and should be worn for 4-5 days continuously. Support hose (compression stockings) are recommended, but not required for laser treatment of leg vessels. They can be used for comfort and to control swelling for 7-14 days after treatment as needed for leg treatments.
Normal daily activities can be resumed the day following treatment. Prolonged standing or leg dependence should be avoided for 6 weeks following treatment, as this will prolong the initial mild swelling that occurs following the injections, but that should be mostly resolved by 10-14 days. Regular exercise can be resumed as tolerated, usually within 4-5 days post treatment. Ibuprofen is beneficial at dosages of 200 mg., 2 to 3 times a day for approximately 10 days to 2 weeks following the injection procedure. If evidence of infection, such as drainage, redness, or unusual swelling occurs in the treated areas, then I would expect you to immediately return to the office for evaluation.
Neodynium: YAG Laser For Treatment of Blood Vessels
Patient Information Sheet
The following information will help you to understand how the Neodynium:YAG Laser is used to clear your vascular lesions.
How does the Neodynium:YAG Laser work?
The Neodynium:YAG Laser produces an intense burst of invisible laser light that selectively destroys fine superficial blood vessels without damaging the surrounding tissue. After laser treatment, the skin overlying the treated area remains intact. The blood vessels clot due to the effect of the laser light energy. They gradually diminish in visibility over several months.
The Neodynium:YAG Laser, at a wavelength of 1064 nanometers, targets blood vessels as deep as 3mm in the skin. It is reliable, safe and comfortable due to its cooling device. The operator can control the delivery of laser energy very precisely.
For vascular lesions, 3-4 treatment sessions 8 weeks apart is needed to achieve maximum improvement. The final result is not expected, and cannot be judged, for 3-4 months following the last treatment. This time line is dictated by the gradual healing of the skin due to new collagen formation, and the obliteration of small blood vessels in the treated areas.
Are there other ways to treat my vascular lesion?
Heredity, skin characteristics, activity (sedentary vs. ambulatory), pregnancy, and physiologic fluctuations in hormonal levels all contribute to the visibility, prominence and recurrence of the small vessels pre and post treatment. The primary treatment for lower extremity spider veins consists of injection with a sclerosing agent, which irritates the vessels and causes blood to clot within them. Injection therapy is to some degree self limited, in that residual vessels become smaller and smaller in diameter and are unable to be cannulated with even the smallest hypodermic needle. These types of vessels are best treated with YAG laser therapy.
Some types of leg telangiectasias are best treated by YAG laser initially. Blue vessels, especially on the legs, are best treated with a Yag laser if injection therapy is not appropriate. Facial telangiectasias (fine, red superficial vessels) are best treated with vascular laser therapy versus injection sclerotherapy, as injections into facial vessels are dangerous. Injection therapy and Yag laser treatment for lower extremity spider veins are complementary procedures whose application must be individualized to clinical circumstances and desires.
For other types of vascular lesions, such as port wine stain birthmarks, stretch marks, scars, facial spider veins or warts, some patients have tried surgery, electrocautery, cryotherapy (freezing the area) or tattooing. These procedures may result in scarring or may leave an unsatisfactory result.
Other lasers such as the Ruby Laser, Argon Laser and CO2 Laser have also been used to treat vascular lesions. These lasers are not as specific to the destruction of the blood vessels in vascular lesions and have resulted in scarring in many individuals. Because of the chance of scarring, the use of these lasers in infants and young children is not recommended.
If you have been treated by other modalities which resulted in scarring or loss of pigment, the lesion may not respond as well with the laser therapy. The scarring or loss of pigment may become more evident after treatment with the laser.
The depth of penetration of the YAG Laser is limited to vessels about 3mm in depth. Therefore, vessels deeper than this may not respond to the therapy.
What should I expect from this laser treatment?
Treatment with the YAG Laser will consist of multiple (3-4) treatments for best results. These treatments occur on an average of every 8 weeks. Individual situations may vary and it is best to discuss yours with Dr. Kuisle, Dr. Hartley, or your IV Seasons Skin Care aesthetician.
The type of vascular lesion to be treated will determine the number of treatments needed.
For some areas, a topical cream anesthetic or local injection can be used if requested. The cooling device included with the YAG Laser treatment automatically cools and numbs the skin prior to the laser light burst. The feeling of a laser pulse has been described as that of being snapped by a rubber band or a slight stinging sensation. Following laser treatment, the area may continue to sting slightly or feel warm like a sunburn for a few hours or days.
If a larger area is to be treated, anesthesia may be used. A small test area can be performed before the entire area is treated to evaluate your pain tolerance. Most patients tolerate this procedure without any need for anesthesia. Applying ice packs to treated areas can alleviate any discomfort experienced following the procedure.
The duration of your laser treatment depends on the size of the area you will have treated or the time allotted by Dr. Kuisle, Dr. Hartley, or their designated operator to perform your treatment. The usual treatment session lasts 15-30 minutes, and may be repeated at a minimum of 8 week intervals.
Are there any adverse effects?
With any laser therapy there is a possibility for adverse effects. The following are adverse effects that may occur with the YAG Laser:
1. The treated area may hyperpigment, or appear darker after the bruising/red discoloration heals. Normal skin color usually returns within 6 months after laser therapy.
2. Scarring is a risk with the use of any laser. If the post treatment skin care instructions are not followed, this can increase the chance of scarring.
3. The treated areas may show a slight depression after the laser treatments. This depression usually resolves within a few months.
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