What is Sclerotherapy and how does it work? Sclerotherapy defined means ´scar treatment.´ Known as one of the more commonly performed cosmetic procedures, this treatment option has evolved to a much more refined treatment for complex varicose and spider veins. Chemicals known as sclerosants are injected into the vein, triggering irritation and inflammation of the vein wall. This inflammatory response triggers the vein to swell and seal, forming a scar within the body. Over time, the scarred vein will shrink and disappear as it is absorbed by the body.
When is Sclerotherapy indicated? Sclerotherapy is indicated for potentially any varicose vein abnormality. Research has demonstrated success in treating saphenous veins, bulging ropey veins, spider veins, recurrent varicose veins after surgery, rescue treatment following thermal ablation, and venous malformations. Though sclerotherapy may be indicated, it may not be the best option for all veins. What is clear, however, is that sclerotherapy plays an important role in any phlebology practice.
• Great and Small Saphenous veins – these veins are commonly diseased and require treatment. Fortunately, we have miles of vein network in each leg, and these veins may be safely treated with many options including: image guided sclerotherapy, surgical stripping and ligation or catheter directed thermal ablation. Though sclerotherapy may be used, it historically has been more prone to recurrences and treatment failures. The weaknesses in traditional sclerotherapy may be disappearing as innovative sclerosants and techniques for this treatment have been producing encouraging results.
• Spider veins/Reticular veins – Sclerotherapy is the gold standard for managing these smaller vessels. Comparative therapies include pulsed light and laser therapies, yet sclerotherapy remains superior in all research to date. Small needles deliver chemicals to clear the dilated surface vessels.
• Ropey/Bulging veins – Sclerotherapy or phlebectomy are indicated for these vessels. Although, sclerotherapy may treat all surface vessels, the treatment option often depends on the condition of the larger veins beneath the skin (saphenous and deep veins).
• Congenital venous malformations (birthmarks, and other lesions) – Sclerotherapy is often the primary treatment option for this condition at the skin or deep to the skin. These often unsightly malformations that may be seen at birth are one of the more challenging conditions to manage. Thorough diagnostic testing is necessary to determine the exact cause of the lesion. Additional therapy may include surgical intervention, or laser therapy.
What complications may be seen from sclerotherapy? Sclerotherapy is considered an exceptionally safe treatment option. Common side effects may include bruising, temporary pain, skin discoloration, and lumps that may persist for weeks after treatment of larger varicose veins. Major complications from sclerotherapy mirror complications from any venous treatment. These include blood clots, potential for infection, and open sores related to chemical burns.
How do insurers view sclerotherapy treatments? This question is entirely dependent upon what veins are being targeted for treatment, and the specific insurance carrier guidelines. Many insurers view sclerotherapy with skepticism because of its cosmetic history, yet advances being made through ongoing research suggest that this view is likely to change in the near future. Sclerotherapy has the potential to deliver complete symptom relief, and durable outcomes, through a lesser invasive and ultimately lesser expensive approach than traditional surgery. The future of vein treatment may indeed be changing.