1. The results of this treatment are not guaranteed. No currently available treatment for varicose veins or spider veins is successful 100% of the time.

2. Varicose veins and spider veins are chronic recurrent conditions. Within 1-6 years after treatment, most patients will have developed new ones which will require additional treatment. For patients with varicose veins, an annual checkup is the only way to discover and treat new varicosities before they become medically significant.

3. SPIDER VEIN INJECTIONS cause the spider veins to break up into smaller vessels, which we refer to as "secondary vessels". In other words, at some point in the treatment, you may see spider veins you didn't have before. Please note further that the treated areas may look worse before they look better. Each successive treatment tends to reduce the size of the remaining vessels, until they are so small that they are no longer a cosmetic problem. This usually requires 5-10 visits to the office, but on occasion, more treatment might be necessary. A single treatment in an area of your leg almost never completely clears the area, even if every vessel is successfully injected. Furthermore, approximately 10% of patients with spider veins have an area somewhere on their leg which never completely clears. In such an area, a dense group of vessels, too small to inject, remains no matter how many treatments are given. To state this more optimistically: in approximately 90% of (completed!) cases, both doctor and patient agree that there has been satisfactory cosmetic improvement.

   The following applies to both VARICOSE and SPIDER VEINS:

4. Immediately after injection, a vein will get hard and lumpy. The veins are longer than they look, and a lump may appear several inches from the actual point of injection. Especially in cases of spider veins, a lump may appear in a place where you didn't think there was a vein at all. These lumps will be tender to the touch for a number of weeks. The lumps normally require 1-6 months to shrink completely. On rare occasions, a lump may persist indefinitely.

5. The skin overlying an injected vein will often develop brown pigmentation after the treatment. The pigment usually requires 1-12 months to fade. In a minority of patients, a few of the spots may require as long as 1-2 years to fade completely. On rare occasions, pigmentation can last for prolonged periods, or even be permanent.

6. Numbness, affecting small areas of skin, occasionally develops after injections. Complete resolution has occurred in all cases we have seen. The numbness disappears gradually over a period of months.

7. Scars: The major side effect of spider vein treatments (and rarely of varicose vein treatments) is scarring. Any medicine which can eliminate an abnormal vein has the potential to burn the skin, leaving a scar. This occurs less than once per 100 office visits. But the typical treatment requires between 5-10 office visits, so the patient's total risk is somewhere between 1-5%. The average scar is about 1/4-inch in diameter (about the size of a clipped pinkie nail). Large and/or multiple scars are also possible, but are exceedingly infrequent in this office.

8. An intense inflammatory reaction, known as superficial phlebitis, develops in approximately 1% of patients after injection of varicose veins (but not spider veins). The reaction is not dangerous, but it is painful. It lasts around a week.

9. Spider veins may break out along the path of a treated varicose vein. They can be injected, but it may not be possible to eliminate them entirely.

10. The worst known complications of sclerotherapy are (1) intraarterial injection, and (2) deep vein phlebitis. INTRAARTERIAL INJECTION: There have been no direct intraarterial injections in this practice since 1991. Prior to that, the incidence was approximately one accident per 1,000 patients. Although none of those patients sustained permanent functional injuries (the injuries were mainly cosmetic), it is possible for intraarterial injection to cause loss of a limb. DEEP VEIN PHLEBITIS: Injection-induced phlebitis, or thrombosis, can theoretically occur in major deep veins, causing the risk of blood clots traveling to the lungs, as well as the risk of permanent vascular insufficiency. Among Dr. Biegeleisen's patients, these have not occurred. On the other hand, a few smaller deep veins have been accidentally injected. Those patients did not suffer life-threatening or long-term complications, but such things remain possible.

11. Arterial bypass surgery, as currently performed, usually utilizes leg veins as grafts. Whether varicose veins should be saved (i.e., not treated) for possible future arterial bypass is a matter of current dispute. It is Dr. Biegeleisen's opinion that saving varicose veins is usually unnecessary. But there may be individual cases in which varicose veins should be saved. Your signature below signifies that you have discussed this question fully with Dr. Biegeleisen.

(The following is filled out at the time of consultation):

FEE: Consult:__________Tests:___________Treatment:___________Other:____________

Please note the following:

(1) Treatment time is ordinarily 20 minutes per session.

(2) The fee quoted here is valid for six months. If you cannot complete the treatment in six months, you must make special arrangements at the beginning. Ordinarily, treatment rendered after six months will be billed on a per-visit, fee-for-service basis.

(The following statement must be signed before treatment can be begun):

"I have read and understood the above statements concerning benefits and risks of injection treatment of varicose & spider veins, and have had ample opportunity to ask questions about it. I hereby request Dr. Biegeleisen and his designated assistants to carry out this treatment".

Signed:____________________________________ Dated:________________