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Spider and Varicose Veins Info
logo spider and varicose veins Naturale Clinic I - São Paulo
Av. Moema , 87 cj 51-52
Moema – São Paulo
Parking : Al. dos Jurupis 452
phone: 55 11 50511075
Naturale Clinic II -Limeira
Avenida Antonio Ometto, 525
Limeira – São Paulo
Phone 55 19 34538490
clinical director
Informations about varicose and spider veins for patients and health professionals
Informações sobre varizes para pacientes e profissionais de saúde
Information à propos des varices et des télangiectasies pour patients et profissionnelles de la santé
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HTML Text Part 1 - What is varicose and spider veins

HTML Text Part 2 - Complications, preventions and FAQ

HTML Text Part 3 -Treatments

PDF Text

Part 3

The Treatments 

We can identify  the treatments as preventive or curatives. The preventive treatment is what reduces the occurrence of new varicose veins and the curative eliminates the varicose veins that already exist. 

The Program of Continuous Treatment of Varicose Veins includes the Sclerotherapy, the Cryosclerotherapy, the LASER , the Microsurgery with local anesthesia, the Microsurgery with epidural anesthesia, the Conventional surgery of varicose veins, the surgery of varicose veins with Endovascular LASER (EVLT),  that will be used according to each kind of problem and to the patient's desire. These are the most modern resources available for the treatment of all of the types of varicose veins of the lower extremities. The Naturale Clinic has doctors who specialize in all the techniques of treatment for varicose veins. They are able to indicate the best treatment options. In the table below,  we see each kind of varicose veins and the adequate treatments. You can also find  details about  each treatment type.  

TYPE

Treatments 

Type 1

Sclerotherapy

Cryosclerotherapy

LASER NdYAG

Pulsed Light 

Microsurgery of Telangiectasies 

Microsurgery with local anesthesia

Microsurgery with Epidural Anesthesia

Continued Varicose veins Treatment - CVT

Type 2

Sclerotherapy

Cryosclerotherapy

LASER NdYAG

Pulsed Light 

Ambulatory Phlebectomy

Conventional Varicose Veins Surgery

Endovascular Venous Treatment - EVLT

Continued Varicose veins Treatment - CVT

Type 3

Ambulatory Phlebectomy

Conventional Varicose Veins Surgery

Endovascular Venous Treatment - EVLT

Type 4

Conventional Varicose Veins Surgery

Endovascular Venous Treatment - EVLT

Sclerotherapy

Sclerotherapy

 

Indication

Type 1 e Type 2

Place for the procedure

Clinic

Rest after the procedure

There is not

Time for the procedure

10 to 20 minutes

Return to  the regular  activities

immediately

Return to Professionals Activities

immediately

Return to Sport  Activities

1 Day

Sun Restrictions

Yes

Cost

 Low Cost

The sclerotherapy is a treatment designed to the elimination of the telangiectasies(spider veins). A very concentrated liquid, called sclerosant,  is injected through micro needles that are extremely thin, inside  the vases. This liquid causes an alteration in the cell of the vase making it disappear. When the liquid continues in the circulation and  reaches the larger vases, it is diluted by the blood and it loses the concentration and, therefore, the effect. This treatment is indicated only for the spiders veins , because if the liquid be applied in larger vases, it can cause stains and serious complications. There is a wide range of substances that can be used and one of the most used is the glucose, due to  the patient's great tolerability and because it does not cause any allergy. To avoid complications, it is not convenient to apply great volumes of sclerosant at a time. That's why the treatment should be made by sessions. In each session,  a certain sclerosant volume that is well accepted by the patient is injected. The  treatments that promise to correct everything in only one day are not suitable, because they increase the risk of complications. The sclerotherapy should not be used in vases of larger caliber. Sclerotherapy, when correctly used in the small vases only,  is very efficient and  doesn't cause any problems. It doesn't cause much pain. It should always be done by specialist doctors, avoiding complications of the treatment that may happen when the treatment is applied by not trained personnel.

Cryosclerotherapy

                                                                      Cryosclerotherapy

 

Indication

Type 1 e Type 2

Place for the procedure

Clinic

Rest after the procedure

There is not

Time for the procedure

10 to  20 minutes

Return to regular activities

immediately

Return to Professionals Activities

immediately

Return to Sport  Activities

2 hours

Sun Restrictions

There is not 

Cost 

 Low Cost

Cryosclerotherapy is a new, low cost and revolutionary method to treat the spiders veins .  

There has always been a desire for a new method, that could be more efficient than the current one. It is a difficult task, because this new method should reduce the number of necessary sessions for the treatment,  decrease any painful sensation that could be caused (the current sclerosant treatment presents little pain),  be free of complications and  have a competitive cost.  

The cryosclerotherapy was created  in Europe and modified by us . We introduced the method in the Naturale Clinic 6  years ago, and we carried out the first research in the University of Campinas to develop new equipment. The new technology  improved and facilitated the application of the method.  

Cryosclerotherapy, a very ingenious method, uses the same products (sclerosants) as the normal sclerotherapy, but an equipment reduces the temperature of the product injected to 40 degrees below zero. The sclerosant in  that temperature, besides  normal effect, has an additional physical effect. The cold  destroys the internal wall, eliminating it. A great reduction in the number of necessary sessions is observed for the treatment and maintenance ( increasing the potency of the treatment). Besides, it decreases the painful sensation that was already small (analgesic effect because of the cold) and reduces   the small equimoses that  appear during the treatment (because of the constriction of the vases, caused by the cold).  

In practice, the researches proved that the treatment reduces  to half the number of necessary sessions for the correction, and it presents less complications. For presenting less equimoses, there are no restrictions to sun exposures and to exercises that  can be taken within some hours after the treatment (after the doctor's authorization). The cost for session is a little larger than the conventional treatment, but because of the reduction of the number of sessions, the final cost of the treatment ends up being lower  than the one of the conventional treatment.  

Our clinic was one of the pioneers in the country to use and to develop this new method. We have already accomplished more than four thousand of sessions of cryosclerotherapy, widely accepted  by the patients, including the current clients who used the old technique and chose to change to this new method.

LASER  for the Spider veins

Nd YAG and Pulsed Light 

                                                     LASER

 

Indication

Type 1 e Type 2

Place for the procedure

Clinic

Rest after the procedure

There is not

Time for the procedure

10 to 20 minutes

Return to regular activities

immediately

Return to Professionals Activities

immediately

Return to Sport  Activities

2 hours

 Restrictions

Sun  30 Days before and 15 Days after

Cost 

High Cost

A treatment that was intensively  studied in the last decade is the LASER. The LASER equipment produces lights with certain characteristics that can be controlled with perfection. These characteristics make the red blood cells in the vases of the skin select and absorb the light. These selective characteristics cause the alteration of the energy inside of the vases to be eliminated, but they don't harm the other tissues around the vases. Therefore, the  objective of eliminating the small vases of the skin is reached.  

The LASER enters the skin without  harming it and reaches the hemoglobin of the vases, which is red. The hemoglobin that  receives the LASER  increases the temperature of the blood and causes the elimination of the vase. 

In the face,  the LASER is more efficient because the vases are very superficial. In other words, a small skin extension exists between the surface and the vases, what reduces risks and  facilitates the treatment.  

The treatment  is accomplished at the clinic, without the need f any anesthesia, allowing the  patient to return to his activities on  the same day. 

There are restrictions for sun exposures before and after the treatment.  

The LASER is the best treatment for the vases of the face and small vases of the lap. For the treatment of the lower extremities, the laser  is not equally efficient for all kinds of vases. Therefore,  we prefer  using the LASER  associated with the cryosclerotherapy. The Laser  can be used  for the smaller and more superficial vases, where it is efficient, and the cryosclerotherapy for the deeper skin vases.   

A new type of LASER, the EVLT, has been used in the surgeries with great efficiency.  It will be mentioned later in  this article  

Microsurgery

The  Microsurgery of Spiders Veins

  The  Microsurgery of Spider Veins 

 

Indication

Type 1

Place for the procedure

Clinic or Day Hospital

Hospitalization 

Not necessary  

Rest

2 Days

Time for the procedure

20 a 30 minutes

Return to domestic activities

2 Days

Return to Professionals Activities

2 Days

Return to Sport  Activities

7 Days

 Restrictions

Sun bath  for 30 to  45 Days

The presence of vases in the skin in the shape of  grapes or  branches is called combined telangiectasies. These formations have a matrix vein  in their base and it is the real  responsible for the small vases of the skin that  appear due to the factors that we already explained. In the Microsurgery of Combined Telangiectasia, these  small veins are extracted with local anesthesia. This surgery stops the flow of the blood in the inverted direction. Later, the telangiectasies (spider veins) are treated by cryosclerotherapy.  The technique is an  easy one; it uses one or two small incisions with less than 1 mm. The incisions are so small that  don't need any type of suture. The patient returns home immediately after the procedure, resting for  2 days.

The  Microsurgery under  Local Anesthesia

  The  Microsurgery under   Local Anesthesia

 

Indication

Type 1

Place of the procedure

Clinic or Day Hospital

Hospitalization after the procedure

Not necessary  

Rest after the procedure

4 Days

Time for the procedure

1  to 3 hours 

Return to domestic activities

4 Days

Return to Professionals Activities

4 Days

Return to Sport  Activities

7 Days

 Restrictions

Sun for  30 to 45  Days

It is indicated for the lightest cases of microvarices. It can be carried out  in a Day Hospital, or in the clinic.  Anesthesia is applied only  in the itinerary of the microvarices. The microvarices are removed through  small incisions; so small that  don't need stitches. The surgery is made using micro-hooks  that  remove the veins and  eliminate them. A rest period of usually three to four days is necessary. After that, the normal activities can be restarted. After seven days, the patient can exercise. It is necessary to avoid the sun for some time, which  varies according to each case. This procedure  removes the reticular veins (microvarices) that are under the skin, forming bluish or greenish lines and that are frequently  related to the telangiectasies or vases. These veins are very frequently on the back of the knee and on lateral area of the thigh and the leg. When they are associated the telangiectasies (spider veins),  they are a source of inverted blood flow and blood stasis.  In other words, they are partly responsible for the emergence of the vases and they should also be treated for better results. It is as if the reticular veins or microvarices were the branches and the vases the leaves.  It doesn't make any sense to treat the leaves and to leave the branches that will bear new leaves after some time.

Microsurgery under Epidural Anesthesia

The  Microsurgery under Epidural Anesthesia

 

Indication

Type 1

Place for the procedure

Day Hospital

Hospitalization after the procedure

Not necessary  

Rest after the procedure

4 Days

Time for the procedure

1  a 3 hours 

Return to domestic activities

4 Days

Return to Professionals Activities

4 Days

Return to Sport  Activities

7 Days

 Restrictions

Sun for 30 to 45  Days

It is basically the  same procedure that can be carried out with local anesthesia, but it's used  for patients who have  a large number of microvarices. In this case the Epidural anesthesia substitutes the local anesthesia. When the varicose veins are in great number, this procedure is more comfortable. The surgery is made at the day hospital. The patient may leave the hospital on the same day. The rest period after the procedure  and the restrictions are the same ones indicated for the treatment with local anesthesia.

Ambulatory Phlebectomy under Local  Anesthesia

A Ambulatory Phlebectomy under Local Anesthesia

 

Indication

Type 2 e 3

Place for the procedure

Day Hospital or Clinic

Hospitalization after the procedure

Not necessary  

Restless

4 Days

Time for the procedure

1  a 3 hours 

Return to domestic activities

4 Days

Return to Professionals Activities

4 Days

Return to Sport  Activities

7 Days

 Restrictions

Sun for 30 to 45  Days

This treatment is indicated for patients who  have collateral varicose veins of larger caliber (medium or big), but in a small number without the involvement  of the saphenous vein. The veins are removed with local anesthesia, as in a microsurgery. The patient can go back  home on the same day. The procedure can be accomplished at day hospital or in the Clinic.

Surgery

Conventional Varicose Veins Surgery 

Conventional Varicose Veins Surgery 

 

Indication

Type 2, Type 3 e Type 4

Place for the procedure

Day Hospital

Hospitalization after the procedure

Not necessary  in most cases -  1 Day in some cases

Rest after the procedure

7 to 30  Days

Time for the procedure

1  to 5,5  hours 

Return to domestic activities

7 to 21 Days

Return to Professionals Activities

7 to 30 Days

Return to Sport Activities

7 to 45  Days

 Restrictions

Sun for 45 to 60  Days

It is a procedure that is accomplished at the Day Hospital or in a General Hospital, for patients with varicose veins of medium and thick caliber: Types 2, 3 and 4. The need of hospitalization will depend on the extension of the procedure, and it may vary from patient to patient.  The time of rest is longer, from 7 up to 30 days. 

This procedure will treat the visible veins and their causes. The Saphenous Veins,  the collateral ones, the perforating, and the reticular veins will be removed if they are sick. Therefore, the "roots" (Saphenous Veins ), the "trunks" (collateral branches) and the "branches" (microvarices) are treated.  The "leaves" (the vases) will be treated later with cryosclerotherapy.  

The choice of the veins to be removed 

During the pre-surgery procedures, the patient goes through a phase that we call "demarcation" of the varicose veins. In this phase, the surgeon draws lines on the patient's legs that identify the sick veins. The veins that should be treated in the surgery were identified in advance in clinical exams or through  ultrasound, showing the doctor  the points that present flow in the inverted  direction or stasis. During the surgery, the surgeon will follow  the previous demarcation, as if it was a project, so that  the results are the best  possible.  

The issue of the Saphenous Veins  

The decision of extracting or not the Saphenous Veins  is a very important one. We have 4 Saphenous Veins . The 4 Saphenous Veins  most of the time are not visible, but the signs of  problems with them are identifiable by specialists.  When they are sick, they should be removed. If the Saphenous Veins are extracted or not, the immediate result is not going to vary much. But in a long term, the varicose veins can reappear  more easily if the sick Saphenous Vein wasn't removed.  The healthy Saphenous Veins,  as "roots" of a tree, do not appear. But if the tree is removed in the level of the earth, without the roots, it will sprout again. Then,  to really control the problem and make the solution work longer, the "roots" - Saphenous Veins - , should be eliminated, if necessary. On the other hand, the Saphenous Veins  although they aren't  important for the  circulation of the blood, they can be used as substitutes or steppes, for the coronary arteries that are the vases of the heart, or for the arteries of members, when these are attacked. But the patient doesn't need to worry; the surgeon will always take the best decision, and only  remove the sick Saphenous Veins that  are useless as substitute. In some cases,  only 1 or 2 that present more alterations  may be removed, leaving the other ones that are normal or with small alterations, preserved for eventualities. In certain situations, the Saphenous Veins  are so altered and cause so many problems that all of them have to be removed. But in these cases, they would be useless as substitutes and they can be eliminated. If they are not removed,  the surgery will fail. If they are necessary  for a substitution in the future and they are not available, then other  techniques can be used, such as the use of mammary arteries and the angioplasties. The Surgeon, using his common sense,  always takes all these factors into account and chooses  the best for the patient.  

Endovascular Laser Treatment  - EVLT

Endovascular Laser Treatment  - EVLT

 

Indication

Type 2, Type 3 e Type 4

Place for the procedure

Day Hospital

Hospitalization after the procedure

Not necessary  

Rest after the procedure

4 to7  Days

Time for the procedure

1  to 5,5  hours 

Return to domestic activities

4 to 7 Days

Return to Professionals Activities

4 a 7 Days

Return to Sport  Activities

7 a 20  Days

 Restrictions

Sun  for 30 Days

This technique has recently arrived from Europe. It is indicated for the varicose veins of larger caliber and its  main advantage is the short resting time after the procedure. Instead of removing the veins of great caliber as the saphenous vein, they are disabled and treated by an optic micro fiber, that transmits the LASER. The vein is not removed but it is disabled and separated from the circulation system. The great advantage is the postoperative that it is much more simple. The surgery produces less bruises too and the patient can return to the normal activities within some days. As all of the treatments, it cannot be used in all of the cases. We have  used this new technique as a routine. Its results have been excellent and the doctors at the Clinic Naturale are very satisfied. Clinic Naturale's doctors have actively  participated in researches related to EVLT in Brazil

The equipment used is a LASER of Diode, that emits a light bunch in the range of the infrared. The  potency used varies from 4 to 15 Watts. An  interesting fact is that a lamp of 15 watts can hardly illuminate a room  for someone to read a magazine, but a LASER of 15 Watts is able  to perforate the magazine. This luminous energy is quite tamed, and used in the medicine in several fields, such as in the Surgery of Varicose veins. 

The equipment imported from Europe is especially developed for this purpose and it is already approved by the FDA of the USA and by the NICE of England, the most rigorous  quality control of medical equipment in the world. It is registered in ANVISA of Brazil also.  

Therefore, The Clinic Naturale can already offer this modern treatment in its two units and in its Day Hospital and Medical Center São Paulo LASER, of which it is one of the owners.

Continued Varicose veins Treatment

The treatments of varicose veins are efficient, but it is important that the patient understands the chronic characteristic of the problem. For this reason, the patient need constant contact with the doctor and new procedures may be necessary in the future.  

As we have  already seen, the varicose veins are a problem caused by a hereditary tendency, which cannot be changed. Therefore, the ones who have this tendency,  will have it forever. The treatment of the varicose veins should be initiated as soon as the first symptoms are felt and must take place for all the patient's life.  A series of applications for the vases is planned (we prefer the cryosclerotherapy), followed by a maintenance treatment with an application per month or an annual series. If after some  time the microvarices appear, a Microsurgery is accomplished with local or Epidural anesthesia. Later, if serious varicose veins, usually after a pregnancy, appear, then a conventional or a LASER Surgery for Varicose veins of Thick Caliber is necessary to solve the problem. With this approach, treating the problems as they appear, the person with tendency to have varicose veins won't have complications. As a result, we have the aesthetic problem solved and the control of a disease that will never present complications. But for efficient and long term results, it is necessary to be aware that the treatment should be made in a continuous and regular way. The patient should always apply the preventive measures and frequently see a Vascular Surgeon / Angiologist that will evaluate the scenario and suggest the necessary treatment. This process is called "Continuous Treatment of Varicose veins Program". It is important to remember that varicose veins don't "appear again" after being treated; what really may appear other veins. That's why the treatment should be continuous. People who already show varicose veins of larger caliber, in fact the situation of most of the people,  can seek for treatment at any time, using the same techniques and making the maintenance since then. 

HTML Text Part 1 - What is varicose and spider veins

HTML Text Part 2 - Complications, preventions and FAQ

HTML Text Part 3 -Treatments

 

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