Ten Things You Can Do To Get Ready For Summer – Number 1

An easily treatable condition that we see frequently in our office in Santa Barbara is telangiectasias of the legs, commonly known as spider veins. They are most common in women, and although pregnancy and aging are the frequently causative, spider veins often just randomly occur. They can occur around areas of previous injury, even a bad bruise. If there appears to be a chance that there may be problems of backpressure from the saphenous vein of the thigh, or the deeper veins of the thigh and lower leg, I will refer the patient for a special kind of ultrasound evaluation. If there are problems with the deeper veins, endovein laser treatment by the radiologist, or perhaps referral to a vascular surgeon may be necessary.

There are basically two ways to treat spider veins (telangiectasias): laser, and injection of a sclerosant. Traditionally, injection was done using hypertonic saline (concentrated salt water), or sclerosants such as polidocanol (Asclera). I don’t like hypertonic saline because it tends to be more painful and also likely has a higher risk of problems such as prolonged bruising and even scarring. Polidocanol works great and is fairly painless, but a leg wrap or compression hose is necessary for about a week. That is one reason that I tend to use the laser as my first choice. Not all lasers are the same, even the ones that claim to work on leg veins, and so I hear lot of trash talk about lasering spider veins. But rarely do I have to switch to injections because the laser isn’t doing the job. The laser we use is an Nd:Yag laser as part of the Lumenis One platform and it does a great job on leg spider veins. I don’t need to wrap or compress the legs after the laser procedure, which is a big plus. Avoidance of running and prolonged standing for about a week is suggested, but normal activities are fine.

Whether we do injections or laser, most people will need about 3 sessions spaced at least 2 weeks apart. Each session generally takes care of about 50% of the problem, so that’s why you need more that one session. As time goes on, you will likely have more spider veins pop up, so don’t expect a cure. The legs do look worse before they look better, so don’t expect to be beach ready immediately. Starting a series of spider vein treatments now will get your legs ready for summer.

Douglas J. Mackenzie, M.D., F.A.C.S.

Santa Barbara, CA

Author
Douglas J. Mackenzie, MD

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