Frequently Asked Questions

What causes spider veins?

Spider veins are caused by similar factors that cause varicose veins and chronic venous insufficiency. These factors include:

• Genetics: Most women with spider veins have mothers and/or female relatives with this vein condition. Weak vein walls and valves, as well as shortage of vein valves, seem to be inherited characteristics and may play a role in determining who develops spider veins and at what age.
   
• Pregnancy: During pregnancy, and to a lesser degree also during periods, fluctuations in the female sex hormones (especially estrogen and progesterone) cause softening of the vein walls and valves. This makes women's veins more prone to stretching and enlargement with increased pressure.
   
  • Increased blood volume, which is needed to provide circulation to the fetus, also cause increased pressure on the vein walls. The growing fetus also exerts pressure on the pelvis, which in turn, exerts pressure on the leg veins.
     
  • Some women see spider veins that develop during their pregnancies and persist after their baby is born. Other see that their veins disappear after the baby is born, only to reappear later in life.
     
• Prolonged standing and sitting: Prolonged standing and sitting cause a great amount of pressure to develop in the leg veins. In both conditions, the calf muscles are inactive and therefore cannot help push the venous blood to return to the heart. This causes blood to pool in the veins, thus resulting in increased pressure on the vein walls.
   
  • This pressure drops once one begins to walk, so if your job requires you to stand or sit for prolonged periods, remember to take short breaks and walk around for a couple of minutes every hour.
     
• Injury: In some people, spider veins appear after injury or trauma to the vein, such as after a broken ankle, surgery, car accident or sports injury. Bruising, which is pooled blood, results from broken veins under the skin, can also lead to an inflammatory response, which in turn, can result in enlarged veins. Sometimes, spider veins can appear many years after the wound has healed.
   
• Vein conditions: In men, spider veins are usually the result of blow-outs from nearby varicose veins. High pressure from these veins causes adjoining superficial veins to stretch, enlarge and change in color. These spider veins are usually darker and have larger diameters than the spider veins in women.
   
  • Spider-vein matting, which resembles bruising that does not go away, is often caused by the healing process of injuries and bruises, as well as complications from sclerotherapy.
     
  • Ankle flares, or spider veins found on the inside ankle, is often associated with chronic venous insufficiency (CVI), a condition where venous blood is not returned efficiently to the heart.
     

The first three factors account for most of the causes of spider veins. Keep in mind that there may be primary and contributing factors to spider veins, and that these factors may not contribute equally to the vein conditions in different individuals.

What is the sclerotherapy procedure like?

Sclerotherapy can enhance your appearance and your self confidence, but it's unrealistic to believe that every affected vein will disappear completely as a result of treatment. After each sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required to achieve optimal results.

You should also be aware that the procedure treats only those veins that are currently visible; it does nothing to permanently alter the venous system or prevent new veins from surfacing in the future.

Before you decide to have sclerotherapy, think carefully about your expectations and discuss them with your doctor.

What is it like after sclerotherapy?

In addition to the compression tape applied during the procedure, tight-fitting support hose may be prescribed to guard against blood clots and to promote healing. The tape and cotton balls can be removed after 48 hours. However, you may be instructed to wear the support hose for 72 hours or more.

It's not uncommon to experience some cramping in the legs for the first day or two after the injections. This temporary problem usually doesn't require medication.

You should be aware that your treated veins will look worse before they begin to look better. When the compression dressings are removed, you will notice bruising and reddish areas at the injection sites. The bruises will diminish within one month. In many cases, there may be some residual brownish pigmentation which may take up to a year to completely fade.

What are the complications with sclerotherapy?

In most cases, the pain, discomfort and swelling associated with the veins disappears within days, and the vessels slowly resolve over several months. Serious complications following sclerotherapy are rare.

• Allergy from the sclerosant (this does not occur with hypertonic saline).
   
• Ulceration. This will eventually heal, leaving a small scar, or may be removed surgically. If an artery is inadvertently treated, the surrounding tissue may die (necrose), which is potentially serious.
   
• Deep-venous thrombosis. The risk is very small when venules are treated but it occasionally follows sclerotherapy of larger varicose veins. It is more likely in those predisposed to blood clotting through inherited thrombophilia, lack of exercise, air travel, after major operations and other reasons. Deep-venous thrombosis may rarely lead to potentially serious pulmonary emboli (clots in the blood vessels of the lungs) in about 1 in every 10,000 procedures.

• Staining or brown pigmentation at the site or along the line of the vein. This occurs in about 30% of patients. In most cases, this resolves, but it may take many months.
   
• Temporary bruising. Bruises at the injection sites; are quite common but resolve within a week or so.
   
• Capillary matting. This is an increase in the number of fine red vessels around the injection site: it may disappear on its own, or can be treated by further injections or a vascular laser.

What are my limitations after sclerotherapy?

Patients are usually able to return to normal daytime activities immediately after sclerotherapy. They should walk for at least 30 minutes a day, especially for the first few days following the procedure. Vigorous physical activities such as weight lifting or aerobics classes are not advised during this time.

What is the stab phlebectomy/light-assisted stab phlebectomy procedure like?

• Stab phlebectomy

Stab phlebectomy is a method of removing varicose veins on the surface of the legs. This procedure can be done in the office under local anesthesia. This procedure involves making tiny punctures or incisions through which the varicose veins are removed. The incisions are so small no stitches are required. Veins are very collapsible such that even large veins may be removed through the tiny incisions used in this technique. The patient is able to walk following the procedure.

• Light-assisted stab phlebectomy

With this technique, the surgeon makes a tiny incision near the varicose veins and threads a slender tube with a light source at its tip underneath the vein cluster. A mixture of saline, lidocaine and epinephrine is infused into the area, providing a further anesthetic and "plumps up" the veins so that they are easily visible. The lights of the operating room are turned off so that the surgeon can see the veins illuminated under the skin. The surgeon then makes a very small incision immediately adjacent to a varicose vein. Taking a size 7 crochet hook that has been filed down and modified for the procedure, the surgeon passes it through the incision, hooks a vein and pulls it through the opening. After turning on the operating-room lights, the surgeon assesses the vein, sets the crochet hook aside and grasps the vein at its base with a tiny mosquito clamp. Using a gentle circular motion, the surgeon dislodges the vein from the skin. Further incisions are made to remove remaining veins.

The empty vein channels are then flushed with solution to help collapse them and prevent bruising and hematomas from any residual blood remaining in the channels. No sutures are used; this allows for continued drainage if needed. A compression dressing is applied to the affected area, and within an hour, the patient goes home with instructions to elevate the leg for 48 hours. The resulting scars look like small freckles.

What is it like after the stab phlebectomy procedure?

After treatment, compression bandages and/or compression stockings are worn. Your physician will advise you how long to wear any bandages or hose. Many physicians recommend that you walk or bike after treatment. This reduces pressure in the veins, increases the flow in the veins and reduces the risk of forming a blood clot.

Will my insurance cover the treatment?

Most medical insurances and even Medicare will cover the cost of the surgery. Pre-authorizations will be obtained by the office; preauthorization does not guarantee payments. Payment is determined at the time the claim is submitted for medical necessity by your medical insurance. Please be sure to check if this is a covered benefit under your policy. If the surgery is done purely for cosmetic purposes, the cost of the procedure is usually not covered by insurances. Please call 310-825-4357 for more information regarding the cost of the procedure.