Facts for Consumers from the Federal Trade Commission
Varicose Vein Treatments -- January 1994
Thousands of people every year consider getting treatment for varicose
veins and spider veins. Advertisements for treating venous disease often tout
"unique,"
"permanent,"
"painless," or
"absolutely safe"
methods _ making it
difficult to decide on the best treatment. If you are considering this
procedure, the following information may help.
Remember, though, this cannot substitute for a consultation with a
properly-trained physician.
What are varicose veins?
Veins can become enlarged with pools of blood when they fail to
circulate the blood properly. These visible and bulging veins, called
varicose veins, are often associated with symptoms such as tired, heavy, or
aching limbs. In severe cases, varicose veins can rupture, or open sores
(called "ulcers") can form on the skin. Varicose veins
are most common in the
legs and thighs.
What are spider veins?
Small
"spider veins" also can appear on the skin's
surface. These may
look like short, fine lines, "starburst" clusters, or
a web-like maze. Spider
veins are most common in the thighs, ankles, and feet. They may also appear
on the face.
Who gets varicose and spider veins?
Varicose and spider veins can occur in men or women of any age but most
frequently affect women of childbearing years and older. Family history of
the problem and aging increase one's tendency to develop varicose and spider
veins.
What causes varicose and spider veins?
The causes of varicose and spider veins are not entirely understood. In
some instances, the absence or weakness of valves in the veins, which prevent
the backward flow of blood away from the heart, may cause the poor
circulation. In other cases, weaknesses in the vein walls may cause the
pooling of the blood. Less commonly, varicose veins are caused by such
diseases as phlebitis or congenital abnormalities of the veins. Venous
disease is generally progressive and cannot be prevented entirely. However,
in some cases, wearing support hosiery and maintaining normal weight and
regular exercise may be beneficial.
Is treatment always necessary?
No. Varicose and spider veins may be primarily a cosmetic problem.
Severe cases of varicose veins, especially those involving ulcers, typically
require treatment. Check with a doctor if you are uncertain.
What procedures are available to treat varicose and spider veins?
Varicose veins are frequently treated by eliminating the
"bad"
veins.
This forces the blood to flow through the remaining healthy veins. Various
methods can be used to eliminate the problem veins, including, most commonly,
surgery or sclerotherapy. Less commonly, laser or electro-cautery treatments
have been used to treat the smallest spider veins, especially on the face.
Surgery to treat varicose veins, commonly referred to as
"stripping,"
is
usually done under local or partial anesthesia, such as an
"epidural."
Here, the problematic veins are "stripped" out by
passing a flexible
device through the vein and removing it through an incision near the groin.
Smaller tributaries of these veins also are stripped with this device or
removed through a series of small incisions. Those veins that connect to the
deeper veins are then tied off. This stripping method has been used since the
1950's.
Spider veins cannot be removed through surgery. Sometimes, they
disappear when the larger varicose veins feeding the spider veins are removed.
Remaining spider veins also can be treated with
"sclerotherapy."
"Sclerotherapy" uses a fine needle to inject a
solution directly into the
vein. This solution irritates the lining of the vein, causing it to swell and
the blood to clot. The vein turns into scar tissue that fades from view.
Some doctors treat both varicose and spider veins with sclerotherapy. Today,
the substances most commonly used in the United States are hypertonic saline
or Sotradecol (sodium tetradecyl sulfate). Polidocanol (aethoxyskerol) is
undergoing FDA testing but has not yet been approved in the U.S. for
sclerotherapy.
During sclerotherapy, after the solution is injected, the vein's
surrounding tissue is generally wrapped in compression bandages for several
days, causing the vein walls to stick together. Patients whose legs have been
treated are put on walking regimens, which forces the blood to flow into other
veins and prevents blood clots. This method and variations of it have been
used since the 1920's. In most cases, more than one treatment session will be
required.
Do these procedures hurt?
For all of these procedures, the amount of pain an individual feels will
vary, depending on the person's general tolerance for pain, how extensive the
treatments are, which parts of the body are treated, whether complications
arise, and other factors. Because surgery is performed under anesthesia, you
will not feel pain during the procedure. After the anesthesia wears off, you
will likely experience pain near the incisions.
For sclerotherapy, the degree of pain will also depend on the size of
the needle used and which solution is injected. Most people find hypertonic
saline to be the most painful solution and experience a burning and cramping
sensation for several minutes when it is injected. Some doctors mix a mild
local anesthetic in with the saline solution to minimize the pain.
What types of doctors provide treatments for varicose and spider veins?
Doctors providing surgical treatment include general and vascular
surgeons. Sclerotherapy is often performed by dermatologists. Some general,
vascular, and plastic surgeons also perform sclerotherapy treatments. You may
want to consult more than one doctor before deciding on a method of treatment.
Be sure to ask doctors about their experience in performing the procedure you
want.
What are the side effects of these treatments?
Carefully question doctors about the safety and side effects for each
type of treatment. Thoroughly review any
"informed consent"
forms your doctor
gives you explaining the risks of a procedure.
For surgical removal of veins, the side effects are those for any
surgery performed under anesthesia, including nausea, vomiting, and the risk
of wound infection. Surgery also results in scarring where small incisions
are made and may occasionally cause blood clots.
For sclerotherapy, the side effects can depend on the substance used for
the injection. People with allergies may want to be cautious. For example,
Sotradecol may cause allergic reactions, occasionally severe. Hypertonic
saline solution is unlikely to cause allergic reactions. Either substance may
burn the skin (if the needle is not properly inserted) or permanently mark or
"stain" the skin. (These brownish marks are caused by
the scattering of blood
cells throughout the tissue after the vein has been injected and may fade over
time).
Occasionally, sclerotherapy can lead to blood clots.
Laser and electro-cautery treatments can cause scarring and changes in the
color of the skin.
How long do results last?
Many factors will affect the rate at which treated veins recur. These
include the diagnosis, the method used and its suitability for treating a
particular condition, and the skill of the physician. Sometimes the body
forms a new vein in place of the one removed by a surgeon. An injected vein
that was not completely destroyed by sclerotherapy may reopen, or a new vein
may appear in the same location as a previous one. Many studies have found
that varicose veins are more likely to recur following sclerotherapy than
following surgery. However, no treatment method has been scientifically
established as free from recurrences. For all types of procedures, recurrence
rates increase with time. Also, because venous disease is typically
progressive, no treatment can prevent the appearance of new varicose or spider
veins in the future.
Is one treatment better than another?
The method you select for treating venous disease should be based on
your physician's diagnosis, the size of the veins to be treated, your
treatment history, your age, your history of allergies, and your ability to
tolerate surgery and anesthesia, among other factors. As noted above, small
spider veins cannot be surgically removed and can only be treated with
sclerotherapy. On the other hand, larger varicose veins may, according to
many studies, be more likely to recur if treated with sclerotherapy.
Be wary of claims touting "major breakthroughs,"
"permanent
results,"
"unique treatments,"
"brand-new,"
"painless," or
"absolutely safe"
methods.
Always ask for specific documentation for claims made about particular
recurrence rates or fewer health risks or cosmetic side effects.
How expensive is the procedure?
Sclerotherapy can cost anywhere from a few hundred dollars to several
thousand dollars, depending on the number of injections and treatment sessions
required and the area of the country where the procedure is performed.
Surgery can cost approximately $600 - $2,000 per leg for the surgeon's fee,
plus charges for anesthesia and hospitalization. Most vein surgery can be
performed on an out-patient basis. Costs can vary depending on how many veins
must be removed and the area of the country where the procedure is performed.
You may want to check to see if the procedure is covered under your
medical insurance. Many policies do not cover costs for elective cosmetic
surgery.
For More Information
If you need to resolve a problem with a doctor regarding treatment for
varicose veins, you may want to contact your county medical society, state
medical board, or local consumer protection agency.
You also may want to report any concerns about advertising claims to the
Federal Trade Commission (FTC).
SOURCE: Write: Correspondence Branch, Federal Trade Commission, Washington, DC 20580.
Although the FTC does not generally intervene in individual disputes,
the information you provide may indicate a pattern of possible law violations
requiring action by the Commission or referral to state authorities.
The information collected here has
been developed over searches on the internet. We are not in any way responsible
for, or endorse, information on other web sites, it is here for public
information. Your doctor is the best source of leg health information and
treatment. We hope you find this information helpful. This article has been
provided courtesy of Ames Walker Hosiery (ameswalker.com) and may be reproduced
for personal use provided no part of this article (including the text contents)
has been changed. Copyright ©
2003 Ames Walker International Inc.
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