Laser Vein Removal Treatment: spider, varicose , and sclerotherapy.

Varicose veins:

Healthy veins return blood to the heart and lungs so it can be re-oxygenated. A system of valves makes this happen by allowing the blood to flow in only one direction. When valves fail or leak, blood flows backward under the force of gravity and distends the veins. This backward flow, called “reflux,” causes blood to pool in the veins, resulting in varicose veins.

Ignoring the situation can result in symptoms such as pain, fatigue, itching, burning, swelling, cramping and throbbing. People who suffer from these symptoms instinctively lie down and elevate their legs to reduce the pooling of blood and relieve their discomfort. However, over time, these symptoms will intensify, and quite often, a person’s varicose veins will become large and “ropelike.” Overly distended varicose veins, especially near the ankle, can rupture and cause profuse hemorrhaging. Some legs can even deteriorate with swelling and dermatitis, which can lead to leg ulcers.

Spider veins:

Spider veins appear to be hormonally induced and can be associated with pregnancy and menstruation. Although spider veins are not usually symptomatic, the feeder veins deeper in the skin can cause discomfort. Many women have a combination of both varicose and spider veins. While they may seek treatment for cosmetic improvement, most female patients seek relief from pain.

Spider veins grow from “reticular” veins, also known as “feeder” veins. These feeders exist in a dense network, and are usually a bit deeper in the skin. They form a network of blue or green veins, sometimes giving a marbled appearance to the skin. They might even be difficult to see in some women because they are a little too deep in the skin. But they’re present nonetheless and must be eradicated in order to get the best results possible, while reducing the chance of recurrence. Many women, not knowing the proliferative nature of spider veins, don't want them treated. These women figure as long as the veins aren’t too ugly, they can avoid treatment and save money. But in reality, when left untreated, spider veins provide a platform for the growth of additional spider veins.

Treatment options: Sclerotherapy versus Laser

We not only treat the unsightly surface spider veins, but also the feeders that actually “feed” them. Treating the feeders treats the source of the problem. This allows us to greatly improve our already sound, long-term results. This procedure is performed in our office and takes less than an hour.

Sclerotherapy is the process of eliminating varicose veins and telangiectasias ("spider-veins") by injecting a solution (sclerosing agent) into the veins, and thereby dissolving
them.

Laser Vein Treatment: The laser beam passes through the skin and penetrates the targeted vessel. The laser energy heats up and coagulates blood inside the vessel. These vessels later dissolve within the body. You may experience a stinging sensation during the treatment, which resolves immediately after the treatment is over.

During Treatment	Shortly After Treatment	In The Weeks After Treatment

Is sclerotherapy for me?
A majority of people who receive sclerotherapy are cleared of their small varicosities, or
see a large improvement. Approximately 10% of patients have fair to poor results, meaning the veins have not disappeared after 6 treatments. Very rarely, the veins can become worse after treatment or new veins may develop. You are a candidate for sclerotherapy if you have spider veins, reticular varicosities, recurrence of varicosities, are advanced in age, or any combination of these.  During your consultation Dr. El-Attar will determine the best plan for you.

Contraindications for sclerotherapy: Pregnancy, patients who are bed-ridden or experience decreased mobility, diabetic patients, obesity, history of deep vein thrombosis, allergies to sclerosing agents, and hypercoagutable states (Lupus, etc.).

How many treatments are required?
The number of treatments is dependent upon a.) the extent of the varicosities and b. ) the patient's agreement to follow post-treatment instructions. One to six treatments may be necessary, and the average is usually three to four.

What are the most common side effects?
Itching -- This depends on the type of solution used. You may feel itching along the route of the vein, normally lasting 1-2 days after treatment.
Telangiectatic making (hyperpigmentation) -- This occurs in approximately 10-30% of patients. You may notice a slight discoloration of brown streaks along the veins after treatment. Rarely, the darkening of the vein may last 4-12 months. It will usually not keep you from continuing treatment. Spontaneous resolution of the hyperpigmentation occurs in 70% of patients at 6 months, and in 99% of patients within 1 year.
Sloughing and ulceration -- This type of reaction may occur at the injection site. It looks like a small blister and heals slowly. If the blister opens, or if it is not well taken care of, it may turn into an ulceration. A scar may develop, but it should return to normal color when the healing process is completed.
Allergic reactions -- These reactions are extremely rare, but may occur if you are allergic to the sclerosing agent used. You may also experience an allergic reaction to the material in the compression stockings (Spandex and Lycra), however this is also rare.
Pain -- You may experience mild to moderate pain at the injection site, with some possible bruising. The veins may be tender after the treatment, and an uncomfortable sensation may run along the route of the vein. This is temporary, usually lasting days.

What are the other side effects?
You may feel burning during the injection of the solution. Sometimes new tiny blood vessels develop after treatment, but this is usually temporary. Transient phlebitis-type reactions (swelling of the veins that may cause your ankles to swell), temporary wheels or blebs (similar to hives), and wound infection, poor healing or scarring may also occur. If an arteriole is injected it may lead to arterial embolism and/or pedal gangrene.

Phlebitis is a rare complication, occurring in approximately 1 out of every 1000 patients. If usually happens in the treatment of veins 3-4mm in diameter or greater. The dangers of phlebitis include: possible pulmonary embolus (blood clot to the lungs that could result in death), and post-phlebitis syndrome (when the blood is not carried out of the legs). This may result in permanent swelling of the legs.

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