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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

TREATMENT OF SMALL VEINS

SENTARA COSMETIC AND LASER TREATMENT CENTER

CHRISTI SILER, R.N.

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
slide4
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
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
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
slide17
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
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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