SPIDER VEINS - Can you help me? Dr. Bush responds to this patient

Last Updated: 6/2/2011

Responses

You need a current ultrasound (US) to make sure there is no refluxing source contributing to these spider varicosities. Many levels connect the venous circuit from deep to superficial. Most of the time, reticular veins are the cause of the spider veins. However, spider veins can have a deeper cause. If you were my patient, I would do an US again. Just because your saphenous vein was removed, does not mean that you do not have a portion of it remaining. Strippings are done without US guidance for the most part. (Stripping is a blind procedure) I agree with you that the ‘Vein Wave’ may not be effective in treating leg veins. I personally have no experience with Vein Wave but have not heard positive reports about the device. I have found VeinGogh (ohmic thermolysis), to be effective in treating smaller spider veins and the company is currently applying for FDA approval. Most of our patients will clear up in 3-5 sessions using combination therapy. You need a good, sound study by your surgeon with you standing up so that he/she can identify the spider complexes and any pathophysiology connected to them. This cannot be done by an RVT without the physician present because the physician must see what the RVT is seeing. You don’t have to limit yourself to surgeons only, since many different medical specialties treat spider veins with good success. Google www.veinexperts.org to find a physician in your area! Submitted by Ron Bush, MD, FACS - 6/2/2011

Dr. Bush, Thanks for your prompt reply. The physician who is treating me is a vascular surgeon. He has used the vein light to identify and illuminate the spider veins and although this is helpful, the spider veins persist (and occasionally multiply) despite numerous sclerotherapy treatments. Yes, I had an ultrasound done a few years ago prior to a laser vein ablation procedure (for a varicosity.) I was not aware that the perforator veins you refer to can cause the small superficial spider veins. When I had a second vein stripping surgery in 2002, the saphenous vein was removed so I assumed these spider veins are unrelated. Am I correct in assuming the spider veins are in no way related to deeper venous insufficiencies, and don’t necessarily have a "source?” When I had the Veinwave trial treatment about 2 months ago, I found it to be basically worthless and I noticed no lightening or disappearance of the spider veins. Are you familiar with Veinwave (thermo coagulation?) It seems more suitable for fine facial veins than for leg veins, although it is entirely possible that the sales representatives who accompanied the Veinwave machine to my physician’s office were not familiar enough with the technology to suggest that a stronger heat source be applied. The only other physician in this area who uses this is a plastic surgeon. I have asked my doctor to contact him for further advice on usage of the machine. The most recent sclerotherapy treatment I received (about 3 weeks ago) did not produce great results. I definitely need follow-up injections but the cost is prohibitive. I plan to speak to my physician about this - I certainly don’t want to continue to be charged for treatments that aren’t working, nor do I believe I should be charged an exorbitant fee to get rid of spider veins. Insurance will not cover this. I am aware of several area physicians who treat spider veins. They are radiologists, dermatologists, plastic surgeons, and even a former ER physician, but I have always felt more comfortable with a vascular physician since this is a venous issue. Thanks for any help or suggestions you can give me. Submitted by Patient - 6/2/2011

Good Morning, Obviously, from your history you have a genetic predisposition to forming recurrent venous issues. Spider veins can be very difficult to treat. However, most can be successfully managed or at least cleared considerably if the source is identified. If you not already done so, please visit our medical blog to see how we use a vein light to identify reticular veins that are often the cause of persistent spider veins. Spider Veins: http://www.bushvenouslectures.com/blog/content.asp?id=1169 Have you had an ultrasound done lately. This should be done very carefully to identify if there is any recurrent reflux or a perforator. In the majority of cases, spiders veins can be cleared if you find the source of reflux, however, there is always a chance for some veins to reoccur. Regarding compression stockings, I find the patients who wear them for at least a week after treatment, have the best results. In our clinic, we use combination therapy which includes sclerotherapy and some type of heat such as laser, ohmic thermolysis, intense pulse light. This helps to hasten the resolution by doing double injury. Foam can be done safely in most patients and can be repeated every 3-4 weeks. Treatments that are not spaced apart can cause more veins to occur-a phlebetic reaction. The maximum safe dose is 9cc of 1% liquid Sotradecol Ò. We use much less concentration as most physicians do. There is more information about spider vein treatment on www.veinexperts.org. If you can take take pictures and email them, I would be glad to look at them. You need a good ultrasound done by an experience physician who knows what to look for. Keep us informed of your progress. Where are you located, I may be able to direct you to someone I know for a second opinion if you so desire. Dr. Bush Submitted by Ron Bush, MD, FACS - 6/2/2011

I have very stubborn spider veins in the thighs and lower legs. After 2 vein stripping surgeries and an ablation, I have no more varicose veins but am troubled by these nuisance and unsightly spider veins. My vascular surgeon treats them with foam sclerotherapy but they fail to disappear. He has also used Veinwave in a trial treatment, with poor results. Do you have any suggestions? What is the maximum percentage of Sotradecol ® that should safely be used? Should foam sclerotherapy treatments be repeated frequently? Does wearing compression stockings truly make a difference after treatment?

Thank you.

Patient