Varicose veins
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Sclerotherapy is a poplar method for eliminating varicose veins that has been in use since 1920s. It involves injecting a solution into the diseased vein, causing a reaction that destroys the vessel wall. Sclerosis (hardening) of the vein and then results. Blood can no longer travel through it, and blood is therefore rerouted through healthy veins. Eventually the varicose vein disappears. Varicose veins represent not only aesthetics issue, but also a potential health risks. In many cases varicose vein treatments are covered by MSI. You may request a referral from your Family Doctor for consultation.
What is Sclerotherapy?
Sclerotherapy is a non surgical treatment for varicose and spider veins which is performed in our clinic. Using a tiny needle, medication is injected. The medication irritates the vein walls so that they stick together and are gradually reabsorbed by the body. Eliminating these diseased veins actually improves the circulation and makes the legs healthier.
What will happen in the first consultation?
You will be asked questions regarding your past health, medication history and symptoms. Dr. Puppala will examine your legs and an ultrasound exam may be performed You will have an opportunity to discuss your condition, the various treatments available and ask any questions. Frequently, the veins can be treated on the same day as the consultation.
What causes vein problems?
Veins carry blood from the legs back to the heart through one-way valve systems. When there is a weakness in the vein wall or a faulty valve, the valve stretches and no longer closes properly. The veins become filled with blood that can’t flow y, causing
pain, swelling, discoloration, sores that won’t heal, and occasionally phlebitis, leg ulcers and blood clots. Vein problems are
much more common in women, particularly those that stand for a living and/or have had children. Venous disease is also
genetically inherited.
What types of vein problems does Dr. Puppala's Clinic treat?
Spider veins and varicose veins are the most common. Other vein problems include chronically swollen legs, recurrent infections, thrombophlebitis, and pregnancy-related problems.
How many treatments are required?
Depending on the type and severity of the varicose veins, the average number of treatments is anywhere between 3 and 5,
however as many as 10 treatments may be required. The larger vessels only require a few (3 or 4) well placed injections with a
stronger solution. They must be treated first. The smaller spider veins may require many points of injection using a weaker
solution. The injections will be stopped at any time if the patient so requests. The number of injections is less important that the
type of sclerosing agent used, its dosage, the site of the injections and the skill of the doctors and their staff.
Diagnosis & Treatment
Diagnosis starts with a careful history and physical exam. Diagnostic tests are often needed to evaluate the extent of disease. If
treatment is indicated, each one treatment takes about 20 minutes. The number of treatments depends on the severity of the
problem. Discomfort after treatment is rare. Most patients leave our office and go directly back to work. We recommend that patients walk for 20 minutes after each treatment.
Insurance Coverage
The diagnosis and treatment of significant problems due to large diseased veins are sometimes covered by MSI. Spider veins
are considered "cosmetic" and therefore do not qualify for most insurance plans. The compression stockings that are recommended are often included in private medical insurance plans.
What are the most common side effects?
All medical treatments entail a certain degree of risk. This will be discussed during your first visit and consent to treatment must be signed before the injections are started. Fortunately, when injections are undertaken by well trained professionals,
complications rarely arise.
Sclerotherapy
Frequently Asked Questions
I have those veins for a reason, right? So, if you inject them, what will my body do for circulation?
There are hundreds of potential routes back to your heart through other veins. The varicose veins are not doing much good for you – the flow is poor. The blood finds a new route.
Is exercise good or bad for varicose veins?
Great question. The answer is “yes” to both. Blood from the feet begins its journey back to the heart through blood vessels called capillaries, which flow into progressively larger veins in the “superficial” venous system just under the skin. It then travels through “perforating veins” into the “deep system” When the blood reaches each new level, specialized (but very fragile) valves hold the blood there. On the next contraction of the calf muscles, the blood is propelled up to the new level. As long as the tubes and valves are working properly, all is well. Strong muscles =great circulation.
But, sometimes, through no fault of their own, people have faulty valve systems. This is especially common in the superficial and perforator veins. When the valves allow backflow, suddenly the strong muscle contraction becomes the enemy, propelling blood BACKWARDS into the superficial veins and making varicose veins worse.
Spider Veins:
In the first few days itching, bruising, aching, redness and swelling are common. Most of these symptoms resolve
spontaneously. You may take Tylenol (acetaminophen), but do not take ASA or related compounds (aspirin, naproxen, and
ibuprofen/Advil) since they may increase bleeding. It may help to elevate the legs and rotate the ankles. Some patients
(particularly those with fair skin) notice small red circles or brown lines after treatments. These are due to the pigment of blood or inflammation and usually resolve within 1 month. 90% of the discolorations resolve with 1 year. A superficial blood clot may develop at the injection site which causes a lump. This will disappear in 2-8 weeks. A small superficial ulceration of the skin overlying the injected vessel may occur. It can leave a small scar. "Matting" refers to the development of new tiny blood vessels in the treated vessel. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 18% of women receiving estrogen therapy (for menopause) and 2 to 4 % of all patients. You will be monitored at the clinic for an allergic reaction (very rare) which can include hives, shortness of breath and swelling around the airway. If this occurs at home, seek medical attention immediately.
Varicose Veins:
In addition to the side effects listed above there are several complications which are unique to varicose vein treatment. Phlebitis (inflammation of the vein) may develop at the site of injection as a firm nodule. This resolves with elevation of the legs, application of a cool pack, rotation of the ankles, tensor bandage and aspirin for 48 hours after treatment. Deep Venous
Thrombosis (DVT) is a very rare complication, seen in approximately 1 out of every 30,000 patients treated for varicose veins
greater that 3 to 4 mm in diameter. DVT will be recognized by pain and swelling of the entire foot. The possible dangers of
DVT include the possibility of a pulmonary (lung) clot and post phlebitic syndrome, in which the blood clot is not carried out of
the legs, resulting in a permanent swelling of the legs. If the sclerotherapy solution becomes lodged in an artery instead of a vein, its occlusion may cause an interruption of the blood supply to an area outside of the limb.
What should I do before a treatment?
Do not take aspirin, ibuprofen or other arthritis medicine for 2 days before and after your treatment because these medications can increase bruising. Do not drink alcoholic beverages or smoke for 2 days before and after your treatment. They may impair healing. Shower and wash your legs thoroughly with an antibacterial soap. Do not shave your legs the day of your appointment.
Do not apply any cream or lotion to your legs, including tanning cream. Bring loose fitting shorts to wear during the treatment.
Eat a light meal or snack 1 - 1½ hours before your appointment. If you sometimes get lightheaded during medical procedures,
consider bringing someone to drive you home.
What should I do after a treatment?
Spider Veins - Your legs will be covered in cotton balls attached with tape, so you are advised to wear dark colored loose fitting
clothing to the session. Remove the cotton balls after one hour. Resume normal activities. Avoid alcohol, ASA, and hot baths
and exercise for 48 hours.
Varicose Veins - If the veins are large, you may be asked to wear your compression stocking for 48 hours. Walk or keep active
for a half hour after the session to maximize results. Bring comfortable walking shoes. If traveling more that 30 minutes to the
office, have someone drive you so that you can move your feet and legs as the passenger. Avoid tanning until the end of
treatment and all the bruises have disappeared, otherwise you tan colour may be irregular. Do not use self tanning lotions for at least one month (it can cause unsightly streaking). Maintain normal activities but avoid strenuous physical activities such as
high-impact aerobics or weight lifting for at least the first 48 hours. Ask Dr. Puppala if you routinely exercise heavily, such as
running. Ask when you can return to normal activities. Avoid prolonged standing and hot baths for 2 weeks. Cool your legs with cold water after each shower. Most people can return to work immediately after a treatment. Do not sit in a “hot tub” for 4 weeks after treatment.
What can I do to prevent varicose veins from coming back after a treatment?
Varicose veins are a chronic illness and are subject to recurrence. At Dr. Puppala’s Clinic, we use the most current methods to
effectively treat visible veins and try to prevent future veins from appearing. In addition, there are several steps that you can take in order to assist your own care:
1. Compression stockings are highly recommended and come in a variety of colours and styles. Use them when your legs
ache, for long trips or for prolonged walking or standing. Dr. Puppala will prescribe the correct strength and size for you.
Wearing stockings increases the effectiveness of treatment by 50% and help to prevent recurrences.
2. Wear comfortable shoes with a 1 - 2 inch heel (running shoes are best).
3. Avoid wearing girdles and ordinary knee high stockings (they impede circulation)
4. Exercise regularly. Avoid standing for long periods and if you do, flex your muscles or sit/lie down with your legs up
periodically. We have a handout on exercises.
5. Venixxa: Venixxa helps relieve signs and symptoms of mild to moderate chronic venous disease, spider veins, varicose veins, pain in the legs, sensation of heaviness, sensation of swelling, functional discomfort. It is available as a prescription or over the counter medication and taken 1 tablet twice daily.
How to get more helpful information
Please feel free to call our office at any time. We have brochures, patient education literature, articles and many other resources we’d be glad to share with you.
Sclerotherapy is a non surgical treatment for varicose and spider veins which is performed in our clinic. Using a tiny needle, medication is injected. The medication irritates the vein walls so that they stick together and are gradually reabsorbed by the body. Eliminating these diseased veins actually improves the circulation and makes the legs healthier.
What will happen in the first consultation?
You will be asked questions regarding your past health, medication history and symptoms. Dr. Puppala will examine your legs and an ultrasound exam may be performed You will have an opportunity to discuss your condition, the various treatments available and ask any questions. Frequently, the veins can be treated on the same day as the consultation.
What causes vein problems?
Veins carry blood from the legs back to the heart through one-way valve systems. When there is a weakness in the vein wall or a faulty valve, the valve stretches and no longer closes properly. The veins become filled with blood that can’t flow y, causing
pain, swelling, discoloration, sores that won’t heal, and occasionally phlebitis, leg ulcers and blood clots. Vein problems are
much more common in women, particularly those that stand for a living and/or have had children. Venous disease is also
genetically inherited.
What types of vein problems does Dr. Puppala's Clinic treat?
Spider veins and varicose veins are the most common. Other vein problems include chronically swollen legs, recurrent infections, thrombophlebitis, and pregnancy-related problems.
How many treatments are required?
Depending on the type and severity of the varicose veins, the average number of treatments is anywhere between 3 and 5,
however as many as 10 treatments may be required. The larger vessels only require a few (3 or 4) well placed injections with a
stronger solution. They must be treated first. The smaller spider veins may require many points of injection using a weaker
solution. The injections will be stopped at any time if the patient so requests. The number of injections is less important that the
type of sclerosing agent used, its dosage, the site of the injections and the skill of the doctors and their staff.
Diagnosis & Treatment
Diagnosis starts with a careful history and physical exam. Diagnostic tests are often needed to evaluate the extent of disease. If
treatment is indicated, each one treatment takes about 20 minutes. The number of treatments depends on the severity of the
problem. Discomfort after treatment is rare. Most patients leave our office and go directly back to work. We recommend that patients walk for 20 minutes after each treatment.
Insurance Coverage
The diagnosis and treatment of significant problems due to large diseased veins are sometimes covered by MSI. Spider veins
are considered "cosmetic" and therefore do not qualify for most insurance plans. The compression stockings that are recommended are often included in private medical insurance plans.
What are the most common side effects?
All medical treatments entail a certain degree of risk. This will be discussed during your first visit and consent to treatment must be signed before the injections are started. Fortunately, when injections are undertaken by well trained professionals,
complications rarely arise.
Sclerotherapy
Frequently Asked Questions
I have those veins for a reason, right? So, if you inject them, what will my body do for circulation?
There are hundreds of potential routes back to your heart through other veins. The varicose veins are not doing much good for you – the flow is poor. The blood finds a new route.
Is exercise good or bad for varicose veins?
Great question. The answer is “yes” to both. Blood from the feet begins its journey back to the heart through blood vessels called capillaries, which flow into progressively larger veins in the “superficial” venous system just under the skin. It then travels through “perforating veins” into the “deep system” When the blood reaches each new level, specialized (but very fragile) valves hold the blood there. On the next contraction of the calf muscles, the blood is propelled up to the new level. As long as the tubes and valves are working properly, all is well. Strong muscles =great circulation.
But, sometimes, through no fault of their own, people have faulty valve systems. This is especially common in the superficial and perforator veins. When the valves allow backflow, suddenly the strong muscle contraction becomes the enemy, propelling blood BACKWARDS into the superficial veins and making varicose veins worse.
Spider Veins:
In the first few days itching, bruising, aching, redness and swelling are common. Most of these symptoms resolve
spontaneously. You may take Tylenol (acetaminophen), but do not take ASA or related compounds (aspirin, naproxen, and
ibuprofen/Advil) since they may increase bleeding. It may help to elevate the legs and rotate the ankles. Some patients
(particularly those with fair skin) notice small red circles or brown lines after treatments. These are due to the pigment of blood or inflammation and usually resolve within 1 month. 90% of the discolorations resolve with 1 year. A superficial blood clot may develop at the injection site which causes a lump. This will disappear in 2-8 weeks. A small superficial ulceration of the skin overlying the injected vessel may occur. It can leave a small scar. "Matting" refers to the development of new tiny blood vessels in the treated vessel. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 18% of women receiving estrogen therapy (for menopause) and 2 to 4 % of all patients. You will be monitored at the clinic for an allergic reaction (very rare) which can include hives, shortness of breath and swelling around the airway. If this occurs at home, seek medical attention immediately.
Varicose Veins:
In addition to the side effects listed above there are several complications which are unique to varicose vein treatment. Phlebitis (inflammation of the vein) may develop at the site of injection as a firm nodule. This resolves with elevation of the legs, application of a cool pack, rotation of the ankles, tensor bandage and aspirin for 48 hours after treatment. Deep Venous
Thrombosis (DVT) is a very rare complication, seen in approximately 1 out of every 30,000 patients treated for varicose veins
greater that 3 to 4 mm in diameter. DVT will be recognized by pain and swelling of the entire foot. The possible dangers of
DVT include the possibility of a pulmonary (lung) clot and post phlebitic syndrome, in which the blood clot is not carried out of
the legs, resulting in a permanent swelling of the legs. If the sclerotherapy solution becomes lodged in an artery instead of a vein, its occlusion may cause an interruption of the blood supply to an area outside of the limb.
What should I do before a treatment?
Do not take aspirin, ibuprofen or other arthritis medicine for 2 days before and after your treatment because these medications can increase bruising. Do not drink alcoholic beverages or smoke for 2 days before and after your treatment. They may impair healing. Shower and wash your legs thoroughly with an antibacterial soap. Do not shave your legs the day of your appointment.
Do not apply any cream or lotion to your legs, including tanning cream. Bring loose fitting shorts to wear during the treatment.
Eat a light meal or snack 1 - 1½ hours before your appointment. If you sometimes get lightheaded during medical procedures,
consider bringing someone to drive you home.
What should I do after a treatment?
Spider Veins - Your legs will be covered in cotton balls attached with tape, so you are advised to wear dark colored loose fitting
clothing to the session. Remove the cotton balls after one hour. Resume normal activities. Avoid alcohol, ASA, and hot baths
and exercise for 48 hours.
Varicose Veins - If the veins are large, you may be asked to wear your compression stocking for 48 hours. Walk or keep active
for a half hour after the session to maximize results. Bring comfortable walking shoes. If traveling more that 30 minutes to the
office, have someone drive you so that you can move your feet and legs as the passenger. Avoid tanning until the end of
treatment and all the bruises have disappeared, otherwise you tan colour may be irregular. Do not use self tanning lotions for at least one month (it can cause unsightly streaking). Maintain normal activities but avoid strenuous physical activities such as
high-impact aerobics or weight lifting for at least the first 48 hours. Ask Dr. Puppala if you routinely exercise heavily, such as
running. Ask when you can return to normal activities. Avoid prolonged standing and hot baths for 2 weeks. Cool your legs with cold water after each shower. Most people can return to work immediately after a treatment. Do not sit in a “hot tub” for 4 weeks after treatment.
What can I do to prevent varicose veins from coming back after a treatment?
Varicose veins are a chronic illness and are subject to recurrence. At Dr. Puppala’s Clinic, we use the most current methods to
effectively treat visible veins and try to prevent future veins from appearing. In addition, there are several steps that you can take in order to assist your own care:
1. Compression stockings are highly recommended and come in a variety of colours and styles. Use them when your legs
ache, for long trips or for prolonged walking or standing. Dr. Puppala will prescribe the correct strength and size for you.
Wearing stockings increases the effectiveness of treatment by 50% and help to prevent recurrences.
2. Wear comfortable shoes with a 1 - 2 inch heel (running shoes are best).
3. Avoid wearing girdles and ordinary knee high stockings (they impede circulation)
4. Exercise regularly. Avoid standing for long periods and if you do, flex your muscles or sit/lie down with your legs up
periodically. We have a handout on exercises.
5. Venixxa: Venixxa helps relieve signs and symptoms of mild to moderate chronic venous disease, spider veins, varicose veins, pain in the legs, sensation of heaviness, sensation of swelling, functional discomfort. It is available as a prescription or over the counter medication and taken 1 tablet twice daily.
How to get more helpful information
Please feel free to call our office at any time. We have brochures, patient education literature, articles and many other resources we’d be glad to share with you.