Sclerotherapy

Sclerotherapy is a technique used to treat varicose veins, spider veins, perforator veins and vascular malformations.  After injection, the veins shrink immediately, and then dissolve over a period of weeks as the body naturally absorbs them. The sclerosing agent permanently damages the inner layer of the vein without causing damage to any other structure. Currently used sclerotherapy agents have been used for this purpose for over 60 years.

Sclerotherapy is the preferred method for eliminating spider veins over laser. While laser only targets the visible spider vein, sclerotherapy also closes the "feeder veins" under the skin that are causing the spider veins, thereby making a recurrence less likely.

Sclerotherapy can be used alone or along with 
radiofrequency ablation, for the treatment of varicose veins. In ultrasound-guided sclerotherapy, ultrasound is used to visualize the underlying vein so the physician can precisely perform the injection in larger and non-visible superficial veins. 

Patients with certain underlying conditions (i.e. blood clots, bleeding disorders, autoimmune disease, hearth failure, patent foramen ovale, stroke, non-ambulatory), or other severe medical diseases, as well as certain migraine headaches, pregnant or lactating should not undergo sclerotherapy. 


Preparation. Certain medications such as Aspirin and non-steroidal anti-inflammatories are suspended a week before sclerotherapy. Patients should bring their compression stockings as well as comfortable, loose pants or a  long skirt to cover the leg bandages  afterwards. Photographs will be taken of the legs before and after treatment, as some insurance companies request pretreatment photographs for documentation purposes.

Technique. The commonly-used sclerosing agents can be used either in their liquid form, or mixed with air in a syringe to create a foam. The foam sclerosant drug is more effective than the liquid one in treating larger veins.

Multiple treatment sessions (2-4) are usually necessary to achieve the desided results. In typical office sclerotherapy session, the doctor cleanses the skin and injects the drug into the surface veins with a tiny needle.  About 5-25 injections are performed each time. No anesthetic is needed for sclerotherapy, as there is little discomfort associated with each injection.  A cotton ball is then applied over the treated vein and the patient's leg is compressed with bandages that are worn usually for 5-7 days after treatment or stockings which are worn for at least 4 weeks . Patients are encouraged to walk immediately.  Most sclerotherapy treatment sessions are short, lasting from 15 to 45 minutes, and spaced over few weeks.

Post-sclerotherapy care. Early ambulation and light exercise are encouraged, however, prolonged periods of standing or sitting, and high-impact activities as running or weight lifting should be avoided.  Also, prolonfed direct sunlight exposure, tanning, hot baths or saunas are not allowed after sclerotherapy. Treated veins are expected to fade over the next few feews.

Possible Complications. While sclerotherapy is a safe procedure and millions of injections have been performed worldwide, it is important to remember that it is a medical procedure, and should not be carried out by other than a physician with training and experience in venous disease. Described complications include skin staining (which usually disappears over time), blushing or matting (which can be treated by injecting the feeding vein), poor response and recurrence. Seldom it may develop a skin breakdown with open wound (0.2% to 1.2%) which may result in scarring. Occasionally, trapped blood in the treated vein causes pain and inflammation, which can be easily removed in the office by a tiny incision made with the tip of a needle. Exceedingly rare are venous blood clots (which potentially may travel to the lungs), visual disturbances and allergic reactions.