The gold standard of treatment for spider veins clinics in NJ is non-surgical treatments including endovenous laser vein ablation and endovenous radiofrequency ablation. Both forms of treatment are catheter based technologies performed using ultrasound guided percutaneous entry. However, ablation is not suitable for all patients due to variable presentations of vein disease and anatomical considerations. In fact, contra-indications to catheter based treatment include: 1) superficial veins close to the skin 2) proximal nerves or arterial circulation 3) tortuous veins.
In these instances, a more suitable treatment is microfoam delivery of polidocanol, otherwise known as foam sclerotherapy. The difference between foam sclerotherapy and the more common and well-known sclerotherapy is the compounding of the sclerosant with mixture of air (nitrogen, oxygen, and carbon dioxide). The elements are in variable concentrations and allow for the liquid sclerosant to be compounded into a foam mixture that adheres better to target vessel walls. This is important for larger targets like varicose veins and in some cases reticular veins. Vein specialists will use either foam or liquid sclerotherapy for spider vein treatment NJ depending on the condition being treated.
- Truncual reflux–best suited for RF ablation or EVLT
- Truncal varicosities–foam sclerotherapy or ambulatory phlebectomy
- Perforating veins–targeted ablation or foam sclerotherapy or phlebectomy
- Reticular veins–foam sclerotherapy
- Spider veins–liquid sclerotherapy or laser treatment of spider veins
Foam sclerotherapy can be aided by ultrasound in certain situations prescribed by the vein doctor. In most vein clinics, the preferred solution is now polidocanol given its efficacy and safety profile. There is also the FDA-approved Varithena that is ideal for large varicose veins, perforators and neovascularization. Varithena comes in 1% polidocanol pre-packaged, but is unique from physician compounded foam sclerotherapy because it is pre-packaged as a low-nitrogen microfoam that clinically has proven to be safer and more efficacious. It can be used on the upper and lower portions of the leg. However, despite the increased safety profile ,the medication should only be administered by qualified vein doctors near me that understand the mechanism of action and appropriate use criteria.
In general, foam sclerotherapy is administered following direct cannulation of the target vein. With polidocanol, the preferred concentration is 0.5%-1.0% depending on the size of the target vein. With generic polidocanol, the liquid sclerosant is mixed with an air-filled syringe in 3:1 or 4:1 ratios until a foam is created. The injected foam has an immediate action on the vein walls inducing chemical ablation; this process continues for months to years as the vein is slow reabsorbed by the body. It is important to inform patients of the possibilities to feel tenderness or lumpy nodules after treatment that may look worse for a period of time, but will heal with good effect. Follow up is important post procedure as per the protocol and is standardized in most vein centers. The post procedure care after sclerotherapy follow up will include a duplex ultrasound to evaluate vein treatment effect and any complications post sclerotherapy.
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