Sclerotherapy is one of the leading treatments for the removal of spider veins, reticular veins, and small varicose veins because it is minimally invasive, safe, and relatively pain-free. Doctors administer sclerotherapy by injecting a sclerant, which is a sterile chemical which irritates the vein lining, into your vein causing it to become inflamed, harden, and eventually be reabsorbed into the body.
To compensate for the loss of the vein, blood circulation is re-routed through healthy veins located deeper within the body, so the outward appearance and sometimes pain associated with the problem vein is significantly reduced.
How your doctor determine if you need sclerotherapy?
Your doctor will first take a complete medical history, making special note of venous injury, clotting issues or previous venous disease. After examining your legs in a standing position, your doctor will identify visible varicose veins, reticular veins, or spider veins. Your doctor will also note changes in color or skin texture which are associated with vein disease and/or blood clots. After a thorough examination, your doctor will be able to determine whether sclerotherapy is right for you.
When is sclerotherapy recommended?
Many patients are bothered by the look of three types of enlarged vein: varicose veins, reticular veins, and spider veins.
- Varicose veins are thickened veins which appear twisted and rope-like.
- Reticular veins, also known as blue veins or feeder veins, are bluish-greenish veins are often seen behind the knee, which can feed into spider veins.
- Spider veins (telangiectasias) are thin, bluish reddish spiderlike network which appear on the surface of the skin, usually on the legs but sometimes on the face and pelvis.
Sclerotherapy remains one of the most successful and oft chosen treatment for small to medium varicose veins and spider veins.
When should sclerotherapy be avoided?
If you are pregnant, over 75 years old or extremely sedentary, sclerotherapy is not for you. Sclerotherapy is also contraindicated if:
- your venous circulation is compromised, such as in the case of peripheral arterial disease (PAD)
- you have clotting problems or are at risk for deep vein thrombosis (DVT) or superficial vein thrombosis
- you have recently experienced vein infection (such as acute phlebitis), or have fever or acute illness
Sclerotherapy is only performed on small to medium sized veins, and not on veins connected to major veins, or veins in which reflux is likely to occur.
Doctors often recommend that their patients stop taking anti-inflammatory drugs (i.e. aspirin or Motrin) one week before treatment. Doctors often wait until patients are off blood thinning medications (anti-coagulants such as warfarin) before performing sclerotherapy. Talk to your doctor about any drugs you are taking prior to treatment.
How is sclerotherapy performed?
Sclerotherapy is considered a simple procedure which can be done in your doctor’s office, without anesthesia. It can take as little as 15 minutes, or up to one hour depending on how many veins are being treated in a session. Your doctor will sterilize the injection with alcohol before starting the procedure. While you lie comfortably on your back with your legs slightly elevated, your doctor will inject a chemical or a mix of chemicals directly into your vein using a small needle. These chemicals will irritate the cell lining and cause inflammation and scarring of the vein wall. Lidocaine or other numbing agents can be mixed in with the sclerant to dull the discomfort.
If several veins are to be treated, larger veins are injected before smaller veins, from the thigh to the calves and ankles. Veins that are most uncomfortable to you are generally injected first before veins which are not painful or uncomfortable. During the injection, you may feel minor pain or burning. Tell your doctor if the sensation feels acute or unbearable. Although it is rare, acute burning may be an indication that the sclera solution has leaked from the vein into the surrounding tissue.
After injection, your vein may look swollen or red, which indicates that the sclerant solution is working. Each injection site will be pressed with gauze or other compression agents. After the procedure is complete, you will be expected to wear compression garments or stockings to encourage circulation.
Compression helps prevent blood from being trapped in the problem vein, and keeps the vein walls intact so that scarring can take place. You can expect to wear compression garments for a minimum of 3-7 days after treatment. Some doctors recommend wearing compression garments for up to 3 weeks for best results.
Walking and mild exercise are often recommended to keep your blood circulating after treatment. You can generally expect to return to work and normal activity the same day as the procedure. Expect a follow-up visit with your doctor 1-2 weeks following the procedure
What is foam sclerotherapy?
Foam sclerotherapy is a type of sclerotherapy which uses a foaming agent mixed with the sclerant. Foam moves the blood out of the vein to allow better contact between the sclerant and the vein wall. Ultrasound is often used to guide the injection of foam during foam sclerotherapy. Foam sclerotherapy is particularly effective for treating larger veins.
Several sclerotherapy sessions may be required to make problem veins disappear completely. If several sessions are indicted, veins are given a minimum of 3-4 weeks to completely heal before another sclerotherapy session. Although treated veins fade permanently after sclerotherapy treatment, many patients will continue to develop vein problems, and new varicose veins and spider veins may develop which require additional treatment.
You can expect that there will be bruising (ecchymosis) and redness at the injection site. This is the normal result of the sclera irritating the vein walls. Bruising should fade within 2-3 weeks of treatment. You may also develop small sores on the skin or darker coloring around the injection site. Good skin care and wearing compression garments should resolve these issues quickly in most patients.
Up to 20% of patients undergoing sclerotherapy experience blood being trapped in the treated vein. Remaining blood will turn brownish and should be absorbed into the body with time, sometimes over the course of several years.
Matting, which are fine, red colored blood vessels, may appear near the injection site. Hormone therapy and obesity make a person more prone to matting, which usually fades within a year.
Less commonly, some people experience serious side effects such as severe inflammation, blood clots, air bubbles, or an allergic reaction to the injected agents. Although these reactions are rare, contact your doctor immediately if you experience difficulty breathing, dizziness, or chest pain.
Updated: October 6, 2014