What causes leg veins?
Leg veins are a result of a backup of blood caused by weak or damaged valves in the veins. The heart pumps blood filled with oxygen and nutrients to the whole body through arteries. Veins then carry the blood back to the heart. Valves inside the veins act as one-way flaps to prevent blood from flowing backwards as it moves up your legs. If the valves become weak, blood can leak back and collect there, causing the veins to get bigger and therefore visible. Leg veins are blue because they are deep and large.

How can I prevent leg veins?
The following will help to prevent your chances of getting visible leg veins: Exercise regularly, don’t cross your legs for long periods of time when sitting, control your weight, don’t stand or sit for long periods of time, elevate your legs when resting, wear elastic support stocking, and avoid tight clothing.

What are varicose veins?
Varicose veins are large blue, dark purple veins. They often bulge from the skin and may even have a cord-like appearance. They are most frequently found on the legs.

What are spider veins?
Spider veins are very small and usually red or blue in color. They are much closer to the surface compared to varicose veins. They can look like a thin red line, tree branches or a spider web. Spider veins can be found on the legs, face, and may cover a small or large area.

Are reticular veins?
Reticular veins are known as feeder veins. They are blue and green veins beneath the surface of the skin. They enlarge because of increased pressure in the vein and can be caused by heredity.

How common are leg veins?
Varicose veins and spider veins are very common. Approximately half of the population 50+ years old has leg veins, so you are not alone!

What factors increase my risk for leg veins? What causes spider veins?
The following factors will increase your risk for leg veins / can cause leg veins:

• Heredity: Having a family member who has leg veins may increase your risk of developing them. Approximately ½ of people who have varicose veins have a family history of them.
• Age: The normal wear and tear of aging cases valves in the veins to weaken and the backup of blood causes visible veins.
• Gender: Women are 2-3 times more likely to develop varicose veins than men, due to changes in hormones.
• with puberty, pregnancy, menopause and with birth control pills.
• Pregnancy: During pregnancy the growth of the fetus increase pressure on leg veins. However, leg veins that occur during pregnancy usually improve within 3-12 months after delivery.
• Overweight and Obesity: Having extra body weight can put additional pressure on veins.
• Prolonged Standing/Sitting: This is especially true with legs bent or crossed, as this causes veins to work harder to pump blood back up to the heart.

Other possible causes include race, posture, occupation, hormones, primary valvular incompetence and incompetent perforating veins.

What is sclerotherapy?
Sclerotherapy is a medical procedure used to treat varicose veins and “spider veins.” During sclerotherapy, the physician injects a solution directly into the affected vein. The solution irritates the lining of the vessel, causing it to swell and stick together. Over time, the vessel turns into scar tissue that fades from view. Sclerotherapy is a well-proven procedure and has been used since the 1930s.

How is sclerotherapy done?
Sclerotherapy is performed in a doctor’s office. The treatment area is cleansed. The solution is injected directly into the blood vessel, using very fine needles. The number of veins injected in one session is variable, depending on the size and location of the veins, and the patient’s overall medical condition.

How successful is sclerotherapy in treating varicose and spider veins?
Sclerotherapy works well for most patients. It is estimated that as many as 50 percent to 80 percent of injected veins may be eliminated with each injection session. A few (less than 10 percent) of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions or a different method, such as laser therapy, may be tried.
In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months. If the veins respond to the treatment, usually they will not reappear. However, new veins may appear over time. If needed, you may return for injections.

How will I know if I am a candidate for sclerotherapy?
Before the procedure, you will have an initial consultation with a vascular specialist who will evaluate your eligibility for sclerotherapy.

You are not eligible for sclerotherapy if you are pregnant, breastfeeding, or are bedridden. You must wait at least three months after delivery before you can be considered for this procedure. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be determined on an individual basis, and will depend on the extremity and the cause of the clot.

Veins that are potentially usable for future surgical bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery) will generally not be considered for injection, unless they are already deemed unusable.

Does sclerotherapy hurt?
Sclerotherapy is generally not a painful procedure. We use a very small needed to inject a liquid solution into the vein. It may cause a small burning sensation, but most of our patients find the pain very tolerable. Plus, the procedure is performed under a local anesthetic, reducing the ability to feel pain.

How many sclerotherapy treatments are usually needed?
At our practice, 90% of patients only require 1 treatment. However in some cases a patient will need need 3-5 treatments, performed 4-6 weeks apart.

Is Sclerotherapy The Only Treatment For Varicose or Spider Veins?
Scleroptherapy is the most common procedure performed on spider veins or varicose veins. It is the most effective treatment available today for elimination of large veins. Not only is it effective in eliminating the unsightly vein but it actually helps prevent the vein from coming back. The sclerosing agent also closes the smaller veins (feeder veins) that contributed to the larger one targeted for treatment. This greatly reduces the odds that the vein will reappear.

Will my insurance cover sclerotherapy?
Insurance companies do not provide coverage for sclerotherapy when it is performed for cosmetic reasons. Some insurance companies cover sclerotherapy for specific medical conditions. Your insurance company may request a letter from your physician concerning the nature of your treatment. Please contact your insurance provider to verify coverage before you consider the procedure. If you have questions about the cost of the consultation, treatment or stockings, please call the Financial Counselor.

Will my insurance cover sclerotherapy?
Insurance companies do not provide coverage for sclerotherapy when it is performed for cosmetic reasons. Some insurance companies cover sclerotherapy for specific medical conditions. Your insurance company may request a letter from your physician concerning the nature of your treatment. Please contact your insurance provider to verify coverage before you consider the procedure. If you have questions about the cost of the consultation, treatment or stockings, please call the Financial Counselor.

What to do before the procedure?
Medications: Prior to sclerotherapy, certain medications should be avoided. Please follow these guidelines:
Tetracycline or Minocin, both antibiotics, may possibly cause a staining of the skin if taken 7 to 10 days before or after sclerotherapy. Ask your doctor about other antibiotic medications you may take, or ask for safe guidelines for discontinuing these medications. If you are required to take an antibiotic before any invasive procedure, such as dental procedures, colonoscopy or surgery, please inform your physician.

Do not take aspirin, ibuprofen (i.e. Advil and Nuprin) or other anti-inflammatory medications for 48 hours before and after sclerotherapy, because these medications may interfere with the action of the sclerosing agent or increase bleeding. Tylenol is permitted. Ask your doctor for specific guidelines before discontinuing any medication.

Prednisone decreases the effectiveness of the sclerosing agent. Ask the doctor who prescribed your prednisone if it can be safely discontinued for 48 hours before the sclerotherapy procedure.

Other guidelines before the procedure 
No lotion should be applied to the legs before or after sclerotherapy. We recommend that you bring a pair of shorts to wear during the procedure.

If you have compression hosiery (support stockings) from previous treatments, please bring them with you so we can make sure they will provide adequate support after the procedure.

How will I feel?
Mild discomfort may occur when the veins are injected, and a cramping sensation may be felt for 1 to 2 minutes when larger veins are injected.

What are the side effects of sclerotherapy?
Side effects of sclerotherapy may include:

• Larger injected veins may become lumpy or hard for several months before resolving.
• Raised, red areas may appear at the injection sites and should disappear within a few days.
• Brown lines or spots on the skin may be noted at the site of the injection, possibly caused by a form of iron that escapes from the blood in the injected veins. In most cases, they disappear within 3 to 6 months, but can be permanent about 5 percent of the time.
• Bruising may occur around the injection site and can last several days or weeks.
• Temporary tiny blood vessels may develop at the treated area. This is called revascularization, “flares,” “mats,” or “blushing.” They may appear days or weeks after the procedure but should fade within a few months and usually do not require further treatment.
• Allergic reactions to the sclerosing agent may occur at the time of the injection and are rarely serious. Symptoms include itching and swelling.
• Other side effects rarely develop after sclerotherapy. If you have any of these rare side effects, please contact your physician immediately:
• Inflammation within five inches of the groin
• Sudden onset of a swollen leg
• Formation of small ulcers at the injection site
• Red streaking, especially in the groin area

What happens after the treatment?
After the treatment you will be able to drive yourself home. You may resume your regular activities and are encouraged to walk.

You will be instructed to wear support hosiery or compression wraps to “compress” the treated vessels. Support items can be purchased at the Cleveland Clinic Pharmacy.
Support stockings purchased from a department store may not be adequate if a heavy compression stocking is prescribed.
For 48 hours after the procedure, please follow these guidelines:

• Avoid aspirin, ibuprofen and other anti-inflammatory medications. Tylenol may be used if needed for pain relief.
• Do not take hot baths or sit in a whirlpool or sauna. You may take showers, but the water should be cooler than usual.
• Wash the injection sites with a mild soap and lukewarm water.
• Do not apply hot compresses or any form of heat to the injected areas.
• Avoid direct exposure to sunlight (including sun tanning and tanning beds).
• Call your physician if you have any concerns or questions after the procedure.