Treatment of small veins
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TREATMENT OF SMALL VEINS. SENTARA COSMETIC AND LASER TREATMENT CENTER. CHRISTI SILER, R.N. Examples of Small Veins. Etiology of Venous Disease. Heredity- Primary cause Pregnancy Obesity Standing or sitting for long periods of time Trauma Incidence- 80% female & 20% male.

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TREATMENT OF SMALL VEINS

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Treatment of small veins

TREATMENT OF SMALL VEINS

SENTARA COSMETIC AND LASER TREATMENT CENTER

CHRISTI SILER, R.N.


Examples of small veins

Examples of Small Veins


Etiology of venous disease

Etiology of Venous Disease

  • Heredity- Primary cause

  • Pregnancy

  • Obesity

  • Standing or sitting for long periods of time

  • Trauma

  • Incidence- 80% female & 20% male


Treatment of small veins

Microanatomy of Venous System

Spider Veins

Reticular Vein

Perforator


Algorithm for small vessel treatment

Algorithm for Small Vessel Treatment

  • Rule out truncal insufficiency- plan to correct if present

  • Determine system involved

  • Identify associated reticular veins

  • Perform appropriate treatment

  • Compression for 5-7 days

  • Follow-up & re-treat in 4-6 weeks


Lateral reticular vein with associated telangiectasia

Lateral Reticular Vein with associated telangiectasia


Small vein treatment options

Small Vein Treatment Options

  • Sclerotherapy- still the Gold Standard

  • Lasers- great adjunct to treatment

  • Non lasers- IPL, Ohmic Thermolysis, Vascutouch

  • Microphlebectomy- for large reticular veins

  • Combination Therapy- BEST OPTION for quickest and cosmetically superior results


The ideal sclerosant

The IdealSclerosant

  • Non-allergenic/ Non-toxic

  • Painless

  • No risk of hyperpigmentation

  • No risk of telangiectatic matting

  • No ulceration

  • FDA approved

  • UNFORTUNATELY, no sclerosant meets all of this criteria


Detergent properties

Detergent Properties

  • Efficient sclerosant- causes intimal inflammation  thrombus formation  fibrous tissue  vein obliteration

  • Painless

  • Low rate of allergies

  • Low rate of pigmentation

  • Extravasation tolerated at low amounts


Reticular veins

Reticular Veins

  • R/O truncal insufficiency/ incompetent perforators

  • Inject reticular veins first

  • Follow with laser/ sclerotherapy to telangiectasias

  • Compression dressing post tx facilitates clotting


Why combination therapy

Why Combination Therapy?

Laser spider veins first

Vessel damage d/t heat

Decreased intimal lumen

Less sclerosant needed

Lower incidence of hyperpigmentation

TWICE THE DAMAGE MEANS TWICE AS FAST!


Lasers not all are created equal

Lasers- Not All are Created Equal

  • 940 nm and 1064 nm most common for treatment of telangiectasias

  • Goal is to cause vessel damage without damaging surrounding tissue

  • No sun exposure or sunless tanning prior to tx

  • Test laser and sclerotherapy at consultation to assess response and candidacy for treatment


Superior cosmetic result with combination therapy

Superior Cosmetic Result with Combination Therapy


Foam sclerotherapy

Foam Sclerotherapy

  • CO2 vs. Room Air

    • CO2 bubbles dissolves

      faster in arterial circulation, thus reducing the risk of adverse event

  • Tessari Method-

    • 1 part solution: 4 parts gas

    • Stopcock, 2 syringes


Foam sclerotherapy1

Foam Sclerotherapy


Treatment of small veins

  • Advantages-

    • Increases surface area of sclerosant, thus reducing amount

      • of drug needed

    • Circumferential contact with intimal wall causes more damage/

    • better result

    • Displaces blood, thus avoiding dilution of drug/ increases

      • efficacy

  • Disadvantages-

    • Patients with PFO may not be candidate

    • Neurological deficits-

      • Migraine

      • Scotoma

    • DVT- clear deep system with foot dorsiflexion immediately

      • post tx and encourage ambulation


Treatment of small veins

a


Treatment of small veins

Before/ After Foam Sclerotherapy


6 weeks after one treatment

6 Weeks After One Treatment!


Facial telangiectasias

Facial Telangiectasias


Adverse sequelae

Adverse Sequelae

  • Post Sclerotherapy Hyperpigmentation- transient

  • Localized Urticaria d/t inflammatory response/ histamine release

  • Angiogenesis/ Telangiectatic Matting- R/O truncal insufficiency or perforators to decrease risk

  • Discomfort at injection site

  • Recurrence- hereditary


Complications

Complications

  • Cutaneous necrosis

  • Superficial thrombophlebitis

  • DVT

  • Nerve Injury

  • Allergic Reaction

  • Migraine

  • Scotoma


In summary

In Summary

  • Reticular veins & associated telangiectasia can be easily treated in the office setting

  • R/O truncal insufficiency or incompetent perforators

  • Microphlebectomy if needed for large reticular veins

  • Laser/ RF first and follow with sclerotherapy

  • Foam sclerotherapy to reticular veins if appropriate candidate

  • Dilute sclerotherapy to telangiectasia

  • Most patients require 3-5 treatments spaced 4-6 weeks apart for optimal results


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