PERSONAL HEALTH : ‘30s Treatment for Varicose Veins Makes a Comeback

No matter how beastly the heat, Sheila Parker wouldn’t wear shorts. Not even to the beach. “I just didn’t want anyone to see my legs,” the 38-year-old San Clemente businesswoman says.

She was self-conscious about the unsightly varicose veins that crisscrossed her legs like a road map. Then she heard about sclerotherapy, a nonsurgical injection technique to obliterate the veins.

Six treatments and $2,400 later, Parker is wearing shorts. And giggling about eyeing even shorter shorts.

Sclerotherapy is catching on, especially in leg-conscious Southern California. In the last three years, at least six specialty vein clinics have sprung up from Beverly Hills to La Jolla. Others are due to open in Riverside and the San Fernando Valley. And more than 100 dermatologists, plastic surgeons and other physicians also offer the treatment.

Sclerotherapy isn’t new. It debuted in the 1930s but was not used as often as the more effective “stripping” surgery, in which veins are cut or tied off.

But sclerotherapy’s comeback, doctors say, is prompted by greatly refined techniques and consumer demand for nonsurgical, quick-recovery treatments.

Proponents claim sclerotherapy fills that bill: Patients can walk out of the doctor’s office and right back to work.

Consumers first must decide, however, who should perform the procedure. That’s not an easy task, considering there’s a turf war raging between doctors who specialize in sclerotherapy and those who devote just part of their practices to it.

The specialists say they do the job more quickly and effectively; the generalists claim their work is just as good and costs less.

The fees range from $150 for a half hour to $300 for specialists.

On one point sclerotherapy advocates agree: It can rule out the need for surgery for all but the worst varicose veins.

About 36 million Americans, mostly women, have varicose veins, often swollen, blue and lumpy, or the smaller spider veins, clusters of threadlike, purplish veins.

“Varicose veins occur when increased pressure in the leg veins prevents blood from returning to the heart normally,” says Dr. Jan Victor Karlin, medical director of the Vein Clinics of America in Beverly Hills. “Some blood pools in the superficial veins and stagnates, stretching and enlarging the vessels. Once veins become varicose or spidery, healthy veins take over their work.” Heredity plays the most significant role in varicose veins, Karlin says. But pregnancy and long periods of standing can aggravate the condition. Eliminating the unsightly veins isn’t just vanity-driven. The vessels can throb, ache and make standing impossible.

In sclerotherapy, a doctor injects a “sclerosing” solution that collapses the walls of the vein. “A scar forms,” says Dr. Charles J. Frahm, co-director of the Weinberg Vein Clinics in La Jolla and Beverly Hills, “and is reabsorbed by the body.”

Doctors disagree on the best sclerosing solution to use--saline or a variety of others. The FDA has approved only one solution: sodium tetradecyl sulfate, according to spokeswoman Susan Cruzan.

But doctors who use other solutions, such as saline, claim they’re just as safe. Whatever solution is used, it stays at the injection site, not spreading to surrounding healthy veins.

Patients say the procedure doesn’t hurt much.

Sheila Mason, a television and movie costumer, rested comfortably on an examining table recently while Karlin injected the solution dozens of times. “I’m aware of the needle going into the vein,” she said, “but there’s no real pain. It feels like little pin pricks.”

Sheila Parker, of San Clemente, rates the treatments as far more comfortable than a trip to the dentist or electrolysis. “Those both hurt worse.”

Patients can return to work immediately after the treatment, says Karlin, but they must wear tape, bandages or special elastic stockings for a few days.

“We tell patients to walk for 30 minutes a day, too,” adds Karlin, because the exercise can help speed healing.

Bruising at the site of the injection is common but other side effects are rare, claims Dr. Brian McDonagh, medical director of Vein Clinics of America. A few patients have fainted at the sight of the needle. Some patients have contracted a mild rash.

A very small number have experienced anaphylactic shock. After treatment, experts say, patients should be closely observed for any allergic reaction. Some doctors even give a test dose and then observe the patient.

The number of treatment sessions needed varies by extent of disease. At Vein Clinics of America, a typical patient needs six treatments and often spends $1,800, says McDonagh. But one Beverly Hills physician charges a typical patient $800 to $1,000 for six sessions. Costs are sometimes insurance-reimbursed.

Some sclerotherapy proponents claim a high success rate--99% or better.

“The veins we obliterate can’t grow back,” McDonagh says. But new spider or varicose veins can appear. “About 10-15% of patients get more spider veins 6 to 12 months later, requiring more treatment.”

Dr. Rhonda Rand, a Beverly Hills dermatologist who modifies patient expectations by telling them, “I can make you 80% better.”

That’s good enough for some patients. “I’m thrilled with the results,” says Mason, who resorted to the treatment primarily for pain relief. “After two treatments, my veins don’t feel as ‘angry’ at the end of the day. They don’t hurt as much.”

Another patient, Mary J. Anderson, a 76-year-old Garden Grove woman, underwent three treatments at a Vein Clinics of America facility but isn’t quite satisfied. “The veins still show some,” reports Anderson who has asked for a full refund, but has only received back doctor’s fees.

In the future, there may be another solution. A few doctors are trying to zap spider veins with a special laser. Available on a limited basis, the laser works somewhat like a microwave oven, killing the targeted veins from the inside out but leaving the surrounding tissues unaffected, says Dr. Karen Sherwood, USC assistant professor of dermatology and plastic surgery.

Pain is minimal, says Sherwood. “It feels like a rubber band being snapped against your skin.” Often, just one treatment is needed, she says, and costs are comparable to sclerotherapy fees.

But sclerotherapy fans are dubious. “Laser would take forever and a day,” says McDonagh, who thinks that treatment is best reserved for “one or two spider veins on the face.” On legs, they can leave scars, adds Rand.

First, Check With Your Doctor

People interested in undergoing sclerotherapy or laser therapy should check with their own doctor first, advises Dr. Karen Sherwood, USC assistant professor of dermatology and plastic surgery.

Once patients get a go-ahead, she suggests asking a specialist who performs sclerotherapy or laser therapy these questions:

* How many such treatments have you done?

* What are your success rates?

* How many treatments are needed and what will each cost?

* What results can I expect and how quickly?

* What are the side-effects?

* Do you observe patients after the procedure in case of allergic reactions?