In the Right Vein

State of the Art Diagnostic Testing That Renders a Solution to Permanently Eradicate Unsightly Spider Veins

Many women over thirty, whether they have had children or not, and a large number of men are troubled by vascular problems centering around unsightly and uncomfortable spider or varicose veins. Though methods are available to correct such problems, doctors in various subspecialties are attempting to perform Sclerotherapy without proper diagnostic techniques or training. The key to successful treatment lies in an accurate diagnosis; without this spider veins can be exacerbated.

Dr. Jospeh Fretta, A New York/New Jersey doctor of internal medicine, phlebologist and president of the New Jersey Vein and Cosmetic Surgery Association, uses state of the art diagnostic testing for his Sclerotherapy patients. One such device called the Doppler, pinpoints improperly working valves where varicose veins have developed and allows doctors to actually hear the valves functioning poorly. “For Sclerotherapy, diagnostic technique and work-up is crucial for a good aesthetic result,” says Dr. Fretta. If not done correctly, dams are built in the vascular system, which causes spider or varicose veins to return. The Doppler, as part of a series of steps in his treatment, is the key to permanent results and helps ensure that unwanted spider and varicose veins will not return.

Though this technology has existed in Europe since 1975, it has only been practiced in the United States since 1985, and the vast majority of practitioners do not have this type of diagnostic technology in their offices. “Most dermatologists do not understand the pathology of venous insufficiency, which is the cause of spider and varicose veins,” says Dr. Fretta. Unlike arteries, veins have more variables, and the reason people get large varicose veins is due to a flaw in the valve system. There is a system of valves in each leg numbering about 154, and the purpose of veins is to return blood to the heart, which pumps blood out to feed body parts, returning to tiny veins. Leg veins return blood uphill against gravity and each leg has a series of check valves pointed upward and inward. The brunt of blood flowing back to the heart is through the deep venous system. When valves connecting the deep system to the superficial system rupture it forces blood to search for the path of least resistance, thus escaping to the superficial system, which causes veins to swell. If large veins start swelling, tiny venous branches begin to swell, as well, and little venials enlarge. In many cases, women can also have a response to estrogen triggered by pregnancy or birth control pills, thus causing dilated veins. Surprisingly, people can get varicose veins without having had a spider vein, but varicose veins can trigger the formation of spider veins.

During the diagnostic procedure, Dr. Fretta first feels the leg to see if the calf is swollen, firm, and indurated, felling out the underlying vein. He then palpates or fees out the underlying vein, uses the Doppler to determine which valves are the problem areas, followed by an ultrasound to visualize where he heard blood flowing in the wrong direction. He inserts tiny needles to those specific areas, and then injects a schlerosing solution to cause the blood to flow properly. Schlerosing agents are what cause the vein to constrict. Finally, the veins are closed off so blood cannot flow from the deep vein system to the superficial system, preventing varicose veins from forming and allowing proper blood flow back to the heart.

Prior to treatment, Dr. Fretta conducts a consultation with each patient and determines, through his diagnostic test, whether injection or surgery should treat the veins. This is made clear by the size of the veins and the force of blood flow. Sclerotherapy typically requires two to fourteen sessions, depending on the severity of each case. After each treatment, patients must wear support stockings overnight, and then daily for one week after each subsequent treatment. Complete resolution of all veins is usually three weeks after the last treatment. Dr Fretta suggests that the cooler months are the best time to undergo Sclerotherapy.

For women who feel self-conscious about going bare legged due to spider veins, Sclerotherapy performed in conjunction with proper diagnostic equipment allows patients to benefit from permanent and aesthetically pleasing results.