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Direct Vision Sclerotherapy (DVS)

What is Direct Vision Sclerotherapy?

DVS is a treatment which involves injection of small amounts of “sclerosant” into visible surface veins. This treatment is also known as microsclerotherapy, and is used to treat the small spider veins which appear on the legs and are often cosmetically disturbing. As well as the purple spider veins there are often feeding “reticular veins”, which are blue/green in appearance, slightly larger and slightly deeper within the skin. Although surface veins are sometimes associated with discomfort in the legs, treatment of these veins does not attract medicare or private health insurance rebates. While often very effective, sclerotherapy for surface veins may require repeated visits for injection sessions. New veins tend to appear over time and these can again be treated with sclerotherapy.

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How does Direct Vision Sclerotherapy work?

A sclerosant is injected directly into the unwanted surface vein, irritating the vein wall and causing the vein to gradually close up and be reabsorbed by the body. The sclerosants used are medications which have been available for many years and have a very strong safety profile. Attention to the appropriate concentration of sclerosant, amount to be used, pressure and placement of injections are important to achieve the best results. Compression of the veins after treatment improves the effectiveness of treatment and reduces side effects.

What are the advantages of Direct Vision Sclerotherapy?

Although not perfect by any means this is the most effective treatment for surface veins. There is minimal down time, with return to normal daily activity immediately, although heavy physical exercise should be avoided for a week. This treatment is much more cost effective than surface laser or IPL for leg veins.

What should I expect?

A DVS treatment for surface veins usually takes 30-45 minutes and during this time you will have a large number of injections. The needles are very fine and the sensation varies from a light pin prick sensation to some injections which resemble a green ant bite for 5-10 seconds. Most people tolerate the treatment well, but it you have a needle phobia or are particularly sensitive on the legs it is possible to use an inhaled painkiller (Penthrox)at the time of treatment. If you do require this, it is necessary to bring someone with you who is able to drive you home as driving is not recommended for 24 hours following use of inhaled Penthrox.

Treatment of surface veins on the legs requires a variable number of treatments depending upon the number of veins and how well they respond to treatment. For most people at least 2-3 treatments are required over a period of 2-3 months. Extensive veins may require more treatment, and occasionally one treatment is sufficient for a good result. Not everyone who has surface veins treated attains a clearance of their bothersome veins and it is rare for ALL surface veins to disappear. For some, a maintenance treatment or two every 1-5 years is needed to keep the veins under control.

After your treatment

At the time of treatment, the veins often become red and inflamed for several hours, although not usually painful once the treatment session is completed.  Following this the veins tend to return to their usual appearance, and there are often bruises on the legs for a week or so following treatment. It can take up to 6-8 weeks for treated surface veins to fade, and so there is not usually any need to repeat treatment before six weeks. Often as veins are beginning to disappear, some surface skin marks or brown discolouration(staining) will appear. Staining is very variable, some people will have little or none, others will develop widespread brown marks. The usual pattern is for this side effect to last 3-6 months, but sometimes it takes longer to fade. Staining seems to be more common in people with darker skin.

Frequently Asked Questions

The answer is “sometimes”. It is difficult to determine whether leg aching is related to surface veins, or just coincidentally present at the same time. Very localised aching in the area of a patch of veins is more likely to improve with treatment.

Usually the answer is no, but there is often a vast visual improvement and this can lead to dramatically increased confidence to wear clothes which do not cover your legs.

It is very common for new veins to gradually appear on the legs but the time of this is not easy to predict, often taking several years.

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