 |
 |
|
The treatment of leg veins is first achieved by determination of the vascular pathology involved. This includes clinical assessment to the degree, location and size of the vessels involved. In addition use of Doppler ultrasound, Duplex imaging, and light reflection rheography can delineate competency of saphenous-femoral and saphenous-popliteal junctions, truncal varicosities, and perforating veins.
Treatment of these vessels is achieved by three basic methods. Surgical ligation and stripping and its variants such as ambulatory phlebectomy are limited to the larger varicosities. Thermal destruction of relatively small vessels either using electrocautery or laser surgery has been somewhat limited both by its failure rate and degree of adverse results. Newer lasers and light sources have received a lot of recent attention, but have yet to be shown clearly in the literature to be as effective as sclerotherapy.
The use of sclerosing agents for the treatment of small and large varicosities of the legs has been described for over 60 years. The problems of this technique have been both the selection of the veins to be treated and the selection of the sclerosant. The highest success appears to be with spider veins, reticular varicosities and smaller perforators without saphenous-femoral incompetence. However the choice of sclerosing agents is even more complicated. Various concentrations and choice of solutions are attempted to be matched to the size and type of vessels. Sotradecol (sodium tetradecyl sulfate) and sodium morrhuate are FDA approved sclerosants with a reputation for multiple side effects including allergic reactions and ulceration. Recently the use of lower concentrations of Sotradecol (0.1%-0.25%) appears to reduce these complications. A second solution, hypertonic saline, to my knowledge is not FDA approved for this indication and is associated with increase pain and cramping, but with effective results. Finally, Aethoxysclerol (polidocanol) a non FDA approved medications usually imported from Europe is a very effective solution without pain, and a lower incidence of complications. This is used in concentrations of (0.1%-1.0%) for spider veins.
The patients are examined for presence of spider veins without evidence of saphenous femoral junction incompetence. Informed consent is obtain including FDA status of solution. The area treated undergoes alcohol prep. Initial treatment begins with a low concentration of the chosen solution. Evaluation after approximately 6 weeks determines if a stronger concentration is necessary on subsequent treatments. I use a 1cc syringe with a 30 gauge needles that is slightly bent to allow a more horizontal approach to the skin and therefore superficial penetration. Reticular varicosities or small truncal varicosities are treated first distally followed by surrounding telangiectatic webs. The amount of solution injected depends upon the size of the vessel and resistance perceived. I usually inject .1-.2cc. and no more than .5cc into any one vessel. Total dose in any treatment session depends upon the specific solution and the concentration used as described by the manufacturer. Local compression is applied and the patient is placed in a position to drain the blood from the legs. External compression using Mediwrap is applied for three days with small vessel treatment and approximately 7 days with larger vessels.; Exercise is limited the first several days and full impact exercise limited for at least a week. Due to variable response rate retreatment may be performed after about 6-8 weeks. |
|
|
|
|
 |
|
