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




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

Microanatomy of Venous System

Spider Veins

Reticular Vein


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


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

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

  • 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


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


  • 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