What causes varicose veins?

Although the exact cause of varicose veins is unclear, a number of factors can play a role in creating them. Family history, gender, leg injuries, pregnancy, and standing for long periods of time all seem to help create the visible or swollen veins in the legs we know as varicose veins.

Varicose veins can be treated. A procedure known as sclerotherapy can make varicose veins fade or disappear in 90% of people treated. The main treatment for both varicose and spider veins of the legs is sclerotherapy.

Sclerotherapy treatment: What is it?

The sclerotherapy procedure uses a very thin needle to inject the veins with a special solution. This solution causes an irritation in the vein wall that results in the vein disappearing or fading out. For tiny spider veins (less than 1 mm, about the thickness of a needle), a combination of sclerotherapy and laser, called sclerolaser, is available.

An average patient requires 2 to 6 sclerotherapy treatment sessions. Each session lasts 15 to 20 minutes and about 30 to 40 veins can be treated per session. For most patients, the majority of offending veins will be treated in the first session. The same veins are re-treated at each visit until the veins clear.

Generally, it will take 3 to 6 weeks after each treatment for patients to see any results. Most patients report a 60% to 80% improvement in their treated veins. Complete elimination of varicose or spider veins, however, is seldom achieved. Approximately 10% of patients have a poor result, with only slight fading of the veins.

There is only a 5% chance of treated veins reappearing. New veins can develop, however. Many patients have sclerotherapy treatments once a year to deal with any new varicose veins.

What can I expect at my first appointment?

At your first appointment, the doctor or nurse will take your health history and discuss risks and expectations with you. The doctor will then make an estimate of the number of treatments you require. At the first treatment session, bring a pair of shorts to change into for the treatments. Also bring pants or a long skirt - after treatment you may have tensor bandages on the treatment areas and you may feel more comfortable covering these.

What can I expect after treatment sessions?

For most patients, the treated areas will look red and inflamed for a few hours. There may be slight bruising at the injection site for 1 to 2 weeks. Then, 3 to 6 weeks after each treatment, the veins will gradually fade out.

For spider veins, tensor bandages will be wrapped around the leg at the treated areas for about 2 hours. For small blue veins that are treated, compression stockings may be required for 4 to 7 days. These bandages or stockings apply pressure to the treated area, which decreases the chance of discolouration and helps in the successful closing of the vein. You can buy compression stockings in a variety of fashionable colours, if you choose.

Normal activities can resume after treatment. The only caution is if you are involved in sports such as advanced aerobics, long-distance running, or heavy weightlifting, you should take a 3- or 4-day break. If large veins have been treated, your activity level may need to be adjusted. The doctor will evaluate your situation and give you a recommendation.

Avoid hot baths, jacuzzis, saunas, and sun beds during the healing process. Heat can cause veins to relax and open up, interfering with the success of the treatment.

What are the risks of treatment?

There are a few risks with sclerotherapy that, even though rare, should be noted.

  • Possible allergic reactions to the sclerosing substance can be treated with antihistamines. If a serious reaction occurs, clinics are equipped with emergency medications and equipment.
  • "Matting" - very fine red veins near the injection site - can occur. Matting normally disappears gradually; however, in a few cases it can be permanent. In this case, lasers can be used to treat matting.
  • A small sore (ulcer) may appear at the treatment site. Sores can be treated, but may take up to 10 weeks to heal, leaving you with a scar at the site. You should tell the clinic if an ulcer appears.
  • In 1 out of 100,000 cases, blood clots in the deep veins or the lungs have been reported. New information seems to indicate that these are not due directly to sclerotherapy, but rather to an underlying disorder or disease. When your health history is taken, you will be asked questions related to clotting disorders.
  • Injection into an artery is a very serious complication, with 9 cases reported in Great Britain by 1985. The dangers of injection into an artery include the possibility of sloughing of tissue or ulceration; the most serious cases have resulted in amputation of the limb or part of the limb.
  • Phlebitis (inflammation of a vein) is a rare complication, occurring in approximately 1 of every 1,000 patients. The dangers of phlebitis include a blood clot to the lungs or deep veins.
  • Some patients may experience temporary pigmentation, brown lines, or spots at the treatment site. This discolouration usually fades after several months. In 2% of these cases, pigmentation will be permanent. However, in most cases it can be treated with laser.
Roxanne Hallgren, RN 
in association with the MediResource Clinical Team