"Sclerotherapy," derived from an ancient Greek word that means “hardening,” is the process of injecting a chemical substance called a sclerosant into a problem vein to induce irritation of the connective tissue and lining of the lumen, or space inside the vein. The inflammation that results will cause the vein to seal shut, harden and eventually disintegrate. Once this occurs, the external physical appearance and any pain associated with the dysfunctional vein are eliminated.
Sclerotherapy is recommended for the treatment of small to medium sized varicose veins and telangiectasias, or spider veins. Varicose veins are large, dark, bulging veins that are raised from the skin's surface. They are caused by defective venous valves, which normally operate to prevent blood from pooling or flowing in an opposite direction. When valves are operating poorly, the blood remains stagnant, over-filling the vein and causing painful throbbing along with the unsightly appearance. Spider veins are smaller than varicose veins and not often painful, though many dislike their aesthetic appearance. They are perpetually dilated veins that can range from dark blue to red in color. Spider veins can be caused by inefficient blood flow and a weakening of the vein's wall due to obesity, pregnancy, or numerous other factors.
A qualified specialist will evaluate a patient's needs and provide recommendations regarding the most effective course of action in the treatment of the patient's varicose or spider veins. The number of treatment sessions and injections per treatment will depend on factors such as the size, depth, and location of the veins requiring treatment.
Sclerotherapy is considered a minimally-invasive procedure and is typically performed on an outpatient basis, by a qualified specialist. The skin covering the treatment area will be cleansed, and the physician will proceed by injecting the sclerosing agent into first the larger veins, then smaller ones, stretching the skin over the veins for even dispersal. One injection is commonly required for every inch of vein, or less if a foaming agent is used. Due to the small diameter of the injection needle, patients are typically comfortable throughout the procedure and no anesthetic is needed. The injection process ordinarily takes from 15 to 30 minutes to perform. A slight stinging or burning sensation is normal during and immediately after the procedure, and will dissipate quickly. Once the injection process is complete, the treatment area will be bandaged and compression stockings applied if the legs were treated, to support the resolution of treated veins and enhance the circulation through healthy veins. Normal activities may be resumed immediately, though strenuous exercise should be avoided for a few days. Secondary treatments, if needed, should be scheduled four to six weeks following the primary treatment, in order for the original results to be fully realized before treating further.
Potential complications of sclerotherapy consist of inadvertent intra-arterial injection, skin ulceration, hyperpigmentation (dark spots), superficial phlebitis, deep vein thrombosis (blood clots), and allergic reaction. Scarring and other complications are uncommon, though possible.
Sclerotherapy procedures have been developing technologically in recent years. The types, textures, and strengths of sclerosing agents have been refined to produce optimal results in both large and small veins in varying locations in the body. Advances in ultrasound imaging provide physicians with increased accuracy in the administration and monitoring of the sclerotherapy treatment. The use of foam sclerosants allows the active chemical ingredients to remain in contact with the vessel wall for an extended period of time, enhancing the effectiveness of the treatments. These and other developments enable physicians to provide increasingly positive results using sclerotherapy.
The American Society of Plastic Surgeons states that 375,328 sclerotherapy procedures were performed in the US alone in 2008. Of these, 99% were performed on women. 76% of sclerotherapy procedures were performed on people over the age of 40, though anyone with unwanted spider veins or varicose veins could be a potential candidate for sclerotherapy procedures.