VENOUS LEG ULCERS
Spider veins are well-defined small veins measuring from 0.1mm to 1mm in diameter and appear on the surface layer of the skin. They may appear as scattered irregular veins but commonly occur in clusters of varying density. They are commonly seen in females (especially post pregnancy) and in elderly people.
Spider veins, also called telangiectasias, are of cosmetic concern to many patients because of their appearance and location, which may be at any site on the thigh, leg, ankle, and foot. But spider veins may also cause symptoms such as :
– Fatigue that increase with prolonged standing or sitting
– Subcutaneous spontaneous haemorrhage
It is not uncommon for patients to change their lifestyles because of the appearance or the symptoms of spider veins of the legs. Women, especially, often change their way of dressing and their activities.
Spider veins occur in most people as a consequence of heredity, as often there is a strong family history of spider veins in parents or grandparents. But some‐ times spider veins by their distribution and density will raise the possibility of venous hypertension from failed valves (incompetence) of superficial or deep veins of the leg. This may range from incompetent reticular veins to incompetent superficial veins such as the great saphenous vein, which courses deep in the fat and near the muscle of the leg.
Reticular veins are the larger bluish veins just beneath the skin surface. These are the so-called “feeder veins” , that may be seen to lead into the spider vein clusters. Reticular veins in most cases feed prominent spider veins on the outside area of the thigh, the so-called lateral subdermic venous plexus, which is commonly first noticed in young women even in the teenage years.
Dense clusters of spider veins along the inside of the ankle and foot should alert the physician to the possibility of incompetence of the great saphenous vein and, when seen at the lateral ankle and foot, the small saphenous vein. Patients with chronic swelling of the lower leg, ankle, and foot from incompetence of the deep veins of the leg will usually have prominent spider veins as well.
Principles of Treatment of Spider Veins of the Leg
At Surekha Varicose Veins Clinic, the principles of successful treatment of spider veins includes the following :
1)Identify a treatable cause if present
2)Produce an irreversible injury to the spider vein and if present, the feeder vein
1)Identify a treatable cause if present – Veins such as the great saphenous vein that have failing valves and are causing venous high pressure should be treated before the spider veins are treated, otherwise the results of the spider vein treatment will be disappointing. Failure of the spider veins to respond or the reappearance of more spider veins soon after treatment commonly is the result of leaving the incompetent saphenous vein untreated.
2)Produce an irreversible injury to the spider vein and if present, the feeder vein – This is the CLaCS treatment, developed by Prof. Kasuo Miyake of Sao Paulo, Brazil. This revolutionary treatment is made possible by the combined use of 3 technologies :
- Augmented reality using the V ein Viewer
– Transdermal laser to treat the “feeder veins”
– Sclerotherapy to treat the feeder veins and spider veins.
A thermal injury is delivered to the feeder veins using a transdermal laser. Then sclerotherapy (chemical injection through a small caliber needle in sufficient amount and concentration to achieve an irreversible injury) is performed on the laser-treated feeder veins. More sclerotherapy is then directed to the spider veins on the skin surface.
Subsequent to this the body’s inflammatory process removes the treated blood vessels. This usually takes only weeks to occur. Larger sized spider veins may take months to totally resolve, and this is especially true if they are located low on the ankle or on the foot.
At Surekha Varicose Veins Clinic, the chemicals used in sclerotherapy are safe, gentle and well tolerated. Patients usually feel only mild to little discomfort during the CLaCS treatment. This is because of the cold air that is directed onto the site of skin treatment during the use of the laser and sclerotherapy. This results in anesthesia of the skin. There is usually minimal or no discomfort afterwards.
Compression stockings are not necessary after the CLaCS treatment. Usual activities may resume immediately, and vigorous exercise may be resumed the following day.