Overview of Spider Vein Treatment
Spider veins, also known as telangiectasias and telangiectatic veins are similar to and often associated with underlying varicose veins, but there are some major differences. Spider veins are smaller in size, beginning as tiny red or blue capillaries that lie close to the surface of the skin and are easily visible. Spider veins are most commonly found on the thighs, calves, ankles or face, where they may be a cosmetic concern.
Not all spider veins require treatment, particularly if they are not causing pain or other physical symptoms. However, some people decide to have them removed for cosmetic reasons. There are two available treatments for spider veins: sclerotherapy and lasers and light.
Sclerotherapy is a relatively inexpensive and long-established outpatient procedure used primarily to treat cosmetic vein issues like spider veins and small varicose veins. Performed since the 1930s, an estimated 2.2 million patients now undergo sclerotherapy each year in the United States. The procedure involves a sclerosing agent being injected directly into the spider vein, which helps gradually reduce their visibility over a few weeks. Depending on the number of veins, the treatment session may last up to 30 minutes and several sessions may be needed for best results. There are a number of sclerosing agents, each with their own unique attributes, including varying benefits and risks. Common complications of this procedure may include discomfort during the procedure such as a burning or cramping sensation in the area where the injection was made, headache, nausea, and vomiting. More serious adverse events may occur, depending on the agent and the circumstances of treatment. To learn more about sclerotherapy, visit the American Venous Forum or the American College of Phlebology websites. See below for important safety information relating to Sotradecol® injection.
Lasers and Light
Lasers and intense pulsed light devices selectively damage or permanently destroy abnormal veins with intense heat energy and are used to treat small spider veins where a needle cannot be used. Bruising of the treatment site is normal and can last for a few weeks. The cost of laser treatment of spider veins usually runs higher than that of sclerotherapy. Complications include burns, skin discoloration and skin necrosis (death).
Important Safety Information for Sotradecol Injection
Sotradecol is contraindicated in patients with previous hypersensitivity to the drug; inflammation or incompetence of superficial or deep veins; phlebitis migrans; acute cellulitis; allergic conditions; acute infections; varicosities caused by abdominal and pelvic tumors unless the tumor has been removed; bedridden patients; diabetes; toxic hyperthyroidism; tuberculosis; asthma; neoplasm; sepsis; blood dyscrasias; and acute respiratory or skin diseases.
Due to the risk of deep vein thrombosis, patients should be evaluated for valvular competency and deep venous patency before treatment and slow injections of a small volume (< 2 mL) should be injected. Patients should be monitored post-treatment for deep vein thrombosis and pulmonary embolism. Extreme caution must be exercised in the presence of underlying arterial disease.
Severe adverse local effects, including tissue necrosis, may occur following extravasation; therefore, take care in intravenous needle placement and use the smallest effective volume at each injection site.
Allergic reactions, including fatal anaphylaxis, have been reported. As a precaution, it is recommended that 0.5 mL of Sotradecol be injected, followed by observation for several hours before administration of a second or larger dose. Emergency resuscitation equipment should be immediately available, and the physician prepared to treat an anaphylactic reaction.
At least 6 deaths have been reported. Four of the deaths were cases of anaphylaxis; one in a patient with a history of asthma, a contraindication to Sotradecol use. Another death was in a patient who was taking an antiovulatory agent. One death (pulmonary embolism) occurred in a patient not taking an antiovulatory agent, treated with sodium tetradecyl acetate. Other adverse reactions reported include pulmonary embolism; local injection site reactions (pain, urticaria, ulceration); permanent discoloration of sclerosed vein segment; sloughing and necrosis of tissue following extravasation of the drug; allergic reactions (hives, asthma, hayfever); headache; nausea; and vomiting.