Advanced Sclerotherapy Treatment For Spider Veins

Sclerotherapy is the gold standard for spider vein treatment utilizing a liquid or foam injection to collapse unwanted veins. Common limitations to sclerotherapy success include sensitivity to needle injections, unseen feeder veins, and incomplete treatment. To address these concerns, Dr. Claudia Datta-Rios and the Vein Specialist Centers of New Jersey have adopted innovative techniques to improve success and patient experience using Cryosclerotherapy with Augmented Reality.

SCLEROTHERAPY TREATMENT

Sclerotherapy treatment sessions are usually 30 minutes in length and involve multiple injections with tiny needles. The injection solution is referred to as sclerosant and irritates the lining of the vessels to cause collapse. With time, the injected veins are reabsorbed by the body using natural mechanisms of healing. The number of treatments varies depending on the distribution and quantity of spider veins, patient healing properties, and the presence of underlying venous disease.

What are Advanced Sclerotherapy Techniques?

Our vein treatment centers have wholeheartedly accepted new advances in sclerotherapy techniques. Our large experience with the newer techniques has provided the real-world experience to see what techniques and treatment options are safe and effective. In the following, we provide information on readily available techniques for effective spider vein removal. Additionally, we will describe newer advances honed at our practice to further enhance patient outcomes. 

Foam Sclerotherapy:  

Foam sclerotherapy uses the same sclerosant as in conventional sclerotherapy, but is prepared as a mixture with air. The solution then takes on a consistency of foam (similar to shaving cream) and during injection is able to displace the blood it comes in contact with and adhere to the blood vessel walls for a longer period of time. As a result, a greater level of injury is induced in the target veins.

Foam sclerotherapy is ideal for larger veins, including larger reticular veins (1-3 mm) and varicose veins (> 3 mm in size). Foam Sclerotherapy can also be considered for spider veins resistant to conventional sclerotherapy.  

Ultrasound Guided Sclerotherapy:  

Feeder veins can be identified with ultrasound and selectively targeted for sclerotherapy treatment. Failing to identify the feeder's veins can be a source of both recurrence and treatment failure.

It is important to utilize ultrasound when large veins are targeted with foam sclerotherapy. The medication can be seen on ultrasound interacting with the diseased veins. Ultrasound is used to identify appropriate target veins and reduce exposure of the concentrated medication to healthy regions and deep vein structures. Ultrasound-guided techniques are performed by physicians.

Light-Guided Sclerotherapy: 

A vein lite is a simple and effective way to illuminate unseen networks of spider and reticular veins. When these veins are not properly treated, the incidence of recurrence is much higher.

Asclera: 

Polidocanol is available both in a generic and brand formulation. The brand name is available as Asclera and is the preferred sclerosant for spider vein treatment. It is the only FDA-approved medication for the treatment of spider veins. Generic polidocanol is becoming less available and is unregulated.  Most generic variations are provided by compounding pharmacies with signification variations in the purity of the sclerosant. Hypertonic saline is rarely used now in most advanced vein clinics due to concerns about skin ulcerations and hyperpigmentation with treatment.  

Advantages of Advanced Sclerotherapy Techniques

The newer formulations of sclerosant used are associated with:

• Increased effectiveness
• Decreased burning with injection
• Decreased incidence of matting, staining, and ulceration

Foam Sclerotherapy is best for treating:

• Larger veins including varicose veins, particularly after vein ablation or phlebectomy.
• Performed only by physicians with ultrasound guidance
• The safety profile has been tremendously improved with pre-formulated compounds with O2:CO2 mixtures that micronize bubbles. The only FDA-approved method for foam sclerotherapy is Varithena.
• Improved results on patients with prior vein stripping and recurrent disease (neovascularization)

Sclerotherapy Complications

Sclerotherapy is effective and safe especially when done with trained experts using appropriate techniques. Most events are minor and require no treatment. These include redness, irritation, phlebitis, bruising, matting, or pigmentation. Pigmentation can last a few weeks to even up to 1 year, with up to 97% improving with time. Early recognition of intravascular coagulum and treatment can minimize the effect.  

Rare skin reactions include skin ulcerations or tissue necrosis. Fortunately, this type of reaction is extremely uncommon but is associated with pain, inflammation, and skin breakdown. It usually becomes apparent 48-72 hours after treatment and is thought to be related to inadvertent arterial injection in the vicinity of treatment. It is possible, the sclerosant can pass from the vein into arterial circulation through arterio-venous connections. Treatment is supportive and requires close follow-up with your vein specialist.  

Serious reactions including anaphylaxis, DVT, and strokes are extremely rare. 

The Latest Advances in Spider Vein Removal

Our enhanced techniques are based on two foundations:

• CryoSclerotherapy
• Polarized lighting

What Is Cryo-Sclerotherapy?

Cryo-sclerotherapy is a variation of the standard sclerotherapy session that reduces the pain from injections.  Cryotherapy uses cold air before and during the injections for an anesthetic effect.  

Why Is Cryo-Sclerotherapy Considered Painless?

During cryo sessions, a continuous flow of cold air is directed to the sites of sclerotherapy injections. The result is the cold air anesthetizes the skin numbing the skin to injections. As a result, the simple procedure becomes relatively painless. This is especially helpful for the treatment of spider veins in sensitive areas like behind the knees and thighs.

What Is Polarized Lighting?

Polarized lighting is a game-changer for the effective treatment of spider veins. Our preferred unit is the Syris polarizing LED light that provides two special functions:  2.5x-3x magnification and a scanning optical system. The optical system provides polarization, allowing our vein doctors to see even the veins underneath the skin that are otherwise invisible to the naked eye. These are known as feeder's veins and are important to identify and treat for effective spider vein removal. 

Who Is A Candidate For Cryo-Sclerotherapy?

Cryosclerotherapy is offered to all our patients at our vein clinic in NYC and is performed by Dr. Claudia Rios. Augmented reality is available at all 12 of our vein clinics, including most recently at the Vein Specialist Centers of Long Island.  Dr. Simon Smith adopted the technique and has found increased long-term success in treating underlying feeder veins. 

To learn more about sclerotherapy or an evaluation for spider vein treatment, contact our vein centers today.