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Vascular Surgery/allergic vasculitis

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QUESTION: I am a seemingly healthy, middle aged, normal weight post menopausal woman. I am not on any medication.  I broke out with a skin rash on the bottom half of both my legs 6 months ago.  A biopsy confirmed allergic vasculitis, with no known cause.  The rash cleared on its own in under a month. I had EVLT closure done on both legs 3 years ago.  Both procedures were uneventful.  Although, I realize you do not do sclerotherapy, I am hoping you can shed some light on whether it is okay for me to go for sclerotherapy on my spider veins.  I asked two different dermatologists and one said it is okay, the other said he would not advise it.
     Also, how likely is it for the allergic vasculitis to recur?  Am I now more likely to develop one of the more severe forms of vasculitis?  Thank you,    Stephanie

ANSWER: Hi as you say, we do not do sclerotherapy. However I have to admit in the past we have done it and that is part of the reason we don't do it anymore. I've seen lots of problems with sclerotherapy, from inadequate elimination of spider veins to open wounds or ulcers as a direct result of the injections. With your allergic vasculitis issues I personally, would refrain from sclerotherapy. As I am sure you know, it is an injection of an irritant, into the vein which causes the vein to have an inflammatory response which over time collapses /clots the vein off. It's the inflammatory response that concerns me. Unless you're having severe pain itching, burning, in these spider veins... I would leave them alone. An unattractive spider vein is much better than ulceration that takes months to heal. With regard to your second question about the allergic vasculitis recurring, it's uncommon however, it certainly can recur. it is common not to be able to identify the source of allergic vasculitis, in my opinion, an injection directly into the area of concern may be too great risk to take. However I have to admit, I tend to want to leave things as they are unless there is a real reason to intervene. So again, if your symptoms are such that you're willing to undertake this risk, go for it.  make sure that you see someone who is well experienced, preferably a board certified vascular surgeon, who does sclerotherapy all day everyday. best of luck, hope this helps. Lauri

---------- FOLLOW-UP ----------

QUESTION: Hi,
     Thank you for your quick response to my question.  Your advice/opinion certainly has given me something to think about.  
     Have you had any experience with anyone who has vasculitis?  How likely is it that I could develop one of the more severe forms of the disease, being that I had a bout of the allergic form?  Thank you. Happy New Year,  Stephanie

Answer
the folks i have worked with who have vasculitis are those with large open wounds on their legs. my understanding is that most folks with allergic vasculitis do not go on to  get a more chronic form, but i would sure steer clear of anything that might stimulate the process over again
lauri

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Lauri Ordway

Expertise

I can answer your questions related to your circulation, your peripheral vascular system. This includes all arteries and veins except those inside the head and inside the heart. For example, neck (carotid), arms (carotid subclavian bypasses to Thoracic Outlet) belly (aortic aneurysm & occlusive disorders, renal artery stenosis), legs (iliac, femoral, popliteal, peroneal, dorasalis pedis, posterior and anterior tibial) arteries. Aneurysm & occlusive disease, atherosclerosis, leg pain, arterial wounds and gangrene, amputation prevention. Arterial Bypass, Reynaud’s, Buerger's disease (thromboangiitis obliterans), Thoracic Outlet and other circulation disorders. Vein disorders: Blood Clots (DVT), post-phlebetic syndrome, varicose veins, venous stasis ulcers. I can help with vascular wounds from diagnosis to treatments. I have worked extensively with VNUS Closure and EVLT (Laser) for varicose veins and can describe pre and post procedure expectations and describe the procedures themselves. I can't help with spider veins or cosmetic vein treatment, we don't do it. I have 15 years of wound care experience, arterial, venous, trauma and diabetic wounds for example. **I CANNOT answer questions about STENTS or STENTING, heart disease, blood pressure, brain aneurysm although I can help with questions about the arteries that go to and from those organs.

Experience

I am a nurse, I worked for 15 years with two terrific peripheral vascular surgeons, and one of them is also the inventor of very innovative wound care products and surgical instruments to make vascular surgery procedures better and faster. I wrote and manage the clinic website and field questions from patients all over the world. I am now working with another vascular surgeon and wound care expert, which has given me an opportunity to widen my horizons as I learn another excellent physician's preferences and benefit from his experiences in this amazing specialty.

Education/Credentials
I am an LPN, licensed in Minnesota

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