Treatment for leg thread veins
Sclerotherapy is a safe and well-established treatment for thread veins on the legs. It has been
used for over fifty years. Although there are a number of alternative treatments which are
effective and preferable for thread veins on the face, it remains the most reliably and
successful treatment for leg veins.
How do I know that my practitioner is reputable?
Ask your practitioner about their training or experience. All sclerotherapists should be insured
and should practice in an environment that meets Health and Safety Regulations. Often it is
best to be recommended to a practitioner.
What are thread/spider veins?
Thread veins are unsightly very small, abnormally dilated blood vessels. They are red/blue in
colour and lie very close to the surface of the skin. Usually they cause no physical problems;
occasionally they may cause discomfort and itching.
Why do I get these veins?
The veins in the legs have to return blood from the feet back up towards the heart against
gravity. There are two main systems of veins in the legs. The deep system lies within the
muscles in the legs and carries the majority of the blood. As the muscles contract the veins are
squeezed and blood moves up the veins. Valves attached to the walls of the vessels prevent
backward flow and as the blood moves up it is drawn into the deep system from the superficial
system in the skin. In healthy veins the valves close and blood only moves in one direction.
Approximately 50% of the population will at some point develop a problem with their veins.
Varicose veins occur when the valves in the veins do not close properly and blood leaks back
against the flow, this is called reflux. Reflux causes a backpressure in the superficial veins,
which are not supported by muscle and can dilate. As they stretch their valves do not close
properly, and so the problem develops, leading to varicose veins and thread veins.
Though varicose veins can be very unsightly and uncomfortable only 2% of sufferers will go on
to develop skin problems such as swelling, pigmentation and leg ulcers caused by the poor
circulation. For this reason the NHS does not usually offer treatment for varicose veins, which
are considered largely a cosmetic problem.
For thread veins, the best results are achieved if there is no underlying reflux. Your practitioner
will assess you for signs of underlying problems and advise you accordingly. Duplex ultra
sound is the best way to properly diagnose your symptoms.
Imagine your thread veins as a puddle on the floor. Your practitioner can mop up the puddle on
the floor. If the puddle is caused by a leak in the ceiling the puddle will return and may get
worse. The Doppler or duplex ultra sound can look in the roof to determine what is causing the
leak and how bad it is thus, giving you and your practitioner a better idea of how best to treat
your veins. Generally it is better to treat the larger veins (the leaking pipe) first. In some cases
removal of these veins may improve the cosmetic appearance of the thread veins without
requiring any further therapy.
Whilst the causes of varicose and thread veins are largely unknown,
experts agree;
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They are usually inherited
Hormonal changes for example with pregnancy and HRT may increase their likelihood.
Trauma/surgery to the legs can cause an eruption of thread veins.
They become more prominent and numerous with increasing age.
Is there anything I can do to stop these veins appearing?
Unfortunately if you have this tendency there is very little that can be done to stop them
appearing. Compression stockings may slow the progression down, but it will not stop them
completely. There is no clinical evidence that any homeopathic remedies will either remove or
stop them appearing. Varicose veins and thread veins may be symptoms of an underlying
problem. Whilst these symptoms can be treated there is no cure to prevent them occurring
again in the future.
There are steps you can take to help:
• Maintain a healthy weight.
• Avoid standing or sitting for long periods, remember the veins need the squeeze of active
muscles to move the blood.
• Wearing compression hosiery will improve the circulation in the legs and manage any
symptoms of poor circulation such as ache or swelling.
• Give up smoking.
What should I expect from my initial consultation?
A full and thorough assessment by your Sclerotherapy practitioner should involve a detailed
discussion of the best treatment options for your legs.
During your initial consultation you should be assessed in a standing position, this enables the
practitioner to fully assess your legs. This can be done by looking and feeling the legs. Some
practitioners may use a handheld Doppler machine to listen to the blood in your veins, whilst
others may recommend that you have an ultrasound. This will visualise the veins and check for
any problems within the veins both superficially and deeper in your legs.
The practitioner should at this time be able to tell you how many sessions you will need and
their cost. This varies according to the quantity and type of veins requiring treatment. Most
sessions take between ½ to 1 hour. You should budget for at least two.
The results after one treatment vary considerably from one client to another. Some veins may
disappear completely whilst others may only fade and some remain unchanged. On
completion of a successful treatment you can expect an improvement in the overall
appearance of 60 – 80%. We hope that you will see enough improvement to increase your
confidence in the way your legs look.
Your susceptibility to thread veins does mean that other thread veins may emerge over a
period of time. In most cases, further treatments will be necessary. Some clients prefer to
return each year whilst others may come back when more veins appear after a few years.
During this initial consultation you should be given a full explanation regarding the side effects
of treatments and the follow up care required. Practices vary, some practitioners may offer to
treat you at the same time as your initial consultation, if this is the case you are under no
obligation to continue with treatment if you do not want to.
What happens during treatment?
The injections are performed with you lying down. A solution is injected with a very tiny needle,
superficially into the veins. This causes the lining of the vein to become sticky and swell.
Compression is then applied to close the veins. Over a period of time the vein will heal closed,
be absorbed into the body and fade away
Practice varies with each practitioner. Research has shown that ideally there should be some
compression of the veins injected. This may be initially with cotton wool/dental rolls and then
with a bandage or compression stocking. Length of time wearing compression again varies
according to the size of veins treated and practitioners' preference. Research suggests that the
longer it is worn the better. Compression assists a better long term appearance and fewer side
effects. Most practitioners suggest at least 24 -72 hours of non stop compression and then for
as long as possible just during the day. Initially if both legs are treated you will be unable to
bath during this time, unless you can do so with out making your stockings/bandages wet.
Does it hurt?
Depending on the solution used, sclerotherapy need not be painful. Occasionally. there may
be a feeling of discomfort in some areas of the leg (this varies from person to person).
What should I expect after treatment?
Once you remove either the bandaging or stockings expect your legs to look worse. There may
be marks from the needle, bruising and often the veins may change from their normal red/blue
colour, to black/brown, and this is all normal and may take a few weeks to settle. Depending
on how quickly you normally heal. Some people find the homoeopathic remedy 'arnica' helps
to improve bruising.
The legs may feel slightly tender for the first few days following treatment. An anti-inflammatory
drug such as ibuprofen is often helpful and walking may help.
After about 4 weeks the veins may show some signs of improvement, the true effect of
treatment is seen between two to three months. Some larger darker flares may continue to
fade for up to six months after the procedure.
The results of treatment can be seen at two to three months after your first treatment.
Is sclerotherapy permanent?
Small vessels will be absorbed by the body over a three month period and should not
reappear. However it is likely that new ones will occur in a similar area. It is possible that larger
veins can reopen over time and may need further treatment to close them again.
What are the Side Effects?
Although safe, sclerotherapy is not entirely without risk. All sclerosing drugs have similar side
effects although their likelihood may vary according to the drug used.
Brown staining (haemocycteine stain) is the most common side effect, it may occur in
approximately 15% of cases. It happens when the vein is not entirely closed, blood is trapped
and clots. In some people iron pigment leaks from the clot and stains the skin over the vessel.
It is more likely to occur in slightly larger veins. This mark is not usually permanent, but may
take 6 –18 months to fade. When exposed to the sun they may darken and take longer to fade.
However, it is usually less unsightly than the original thread veins. In the unlikely event that the
stain does not fade (less than 5%) it is possible to have laser treatment to reduce the brown
marks.
Immediately after sclerotherapy you may experience some swelling around the ankle or knee
joints. This settles spontaneously after the first 24 hours. You may find that raising your leg
whilst sitting helps this to settle.
Other less common side effects may be:
Telangiectasia matting, this occurs if the fragile vessel is injured during the injection leaving a
mat of tiny vessels that looks like blush or red bruise. It usually disappears without needing
further treatment over a period of 6 –12 months. If it persists it may be possible to treat with
further sclerotherapy.
Blistering, in rare cases the skin overlying the vein may blister, in extreme cases this may
cause small scabs (feet and ankle areas are most vulnerable), it can potentially lead to a small
scar. Occasionally the stocking may rub and cause small blisters these will settle
spontaneously if left alone.
In larger veins it is possible for the vein to become lumpy, tender and warm where blood
remains in the vessel. Though normal in larger veins as they heal, if this if very uncomfortable
please seek advice from your practitioner. This normally settles without problem over a few
weeks, it may resolve more quickly by using anti-inflammatory drugs and wearing the
compression hosiery. If you are concerned you should discuss it with your practitioner.
Very rarely after about 2-3 weeks a small area of redness and a throbbing sensation may
appear with a white or black centre. If this occurs you should seek medical advice with your
practitioner, prompt treatment with antibiotics prevents any worsening.
Allergic reaction to the agents used is incredibly rare and vary according to the sclerosant
used, Your practitioner would be able to discuss the incidence of their own specific drug. Any
reaction would occur during the session and your practitioner would cease treating you
immediately. Some people feel faint as they do not like needles! Itching and some redness is
common during the treatment, it is not a cause for concern.
It is possible for the treatment to have little or no effect. Results unfortunately cannot be
guaranteed.
What happens after the sclerotherapy?
Each practice tends to have individual post treatment schedules, but they should all suggest:
• Walk immediately after treatment.
• Wear your compression hosiery continuously day and night as for 72 hours. During this time
you will not be able to take a bath.
• Expect your legs to appear worse on removal of the stockings, at this stage this is normal.
They may look worse for up to 2 weeks post treatment.
• Avoid extremes of temperature for up to 2 weeks i.e. Very hot baths, saunas.
• Avoid sun exposure for 4 weeks, pigmentation may take longer to fade.
• Avoid high impact exercise for up to 1 week.
• Elevate your legs as much as possible for the next 2 weeks.
• Consider delaying long haul travelling for at least 6 weeks post treatment or check with your
travel insurance company.
You may require a follow up sessions.