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What is Sclerotherapy?
Sclerotherapy is a procedure used to eliminate varicose and spider veins. It involves the injection of a solution directly into the vein. The solution irritates the vessel wall lining causing the vein wall to swell and stick together eventually causing the vein to turn into microscopic scar tissue that fades over time. It is considered the gold standard of vein treatment for leg veins less than 4 mm in diameter. Sclerotherapy is a well-proven treatment for vein disease and has been in use since the 1930’s.
SOLUTIONS USED FOR SCLEROTHERAPY
There are many sclerosing agents available and are classified into three groups based on their mechanisms of destruction on the endothelium.
The most common agents used in the United States are hypertonic saline, Polidocanol and Sotradecol. Sotradecol, sodium morrhuate and hypertonic saline are FDA approved.
The goal is to use the minimum sclerosant concentration and volume that will cause irreversible damage to the endothelium of the abnormal vessel wall while leaving adjacent normal vessels intact.
Hypertonic Saline is a weak solution, quite painful as it causes muscle cramping, is prone to hemosiderin staining and can cause significant necrosis and ulcerations.
Sotradecol is relatively painless, rarely causes anaphylaxis, is expensive and often results in hyperpigmentation problems post-treatment.
Polidocanol is always painless, cutaneous necrosis is low, effective at low concentrations, not FDA approved, may cause urticaria at the injection site, and people with Sulfa reactions may not be able to use it.
Chromated Glycerin is a weak solution used for the tiniest of vessels used widely worldwide but rarely in the US. The “beginner’s sclerosant.”
Treatment always starts from as high up in the leg as possible and then move down toward the foot. Bigger veins are treated first then progressing down to the to smaller veins.
Treatments on the same general area are spaced 6 – 8 weeks apart. You must be off of all blood thinners (such as Coumadin) 7 – 10 days prior to treatment, refrain from sunbathing post-treatment, and refrain from heavy lifting for 3 days post and comply with the recommended length of post-treatment compression stockings.
To avoid any serious complications, we may need to test a small area before moving onto larger treatment areas.
Studies have shown that as many as 50% – 80% of injected veins may be eliminated with each session of sclerotherapy. Less than 10% of the people who have sclerotherapy do not respond to the injections at all. In these instances, a different solution can be tried. Although this procedure works for most patients, there are no guarantees for success.
In general, spider veins respond in three to six weeks, and larger veins respond in three to four months. If the veins respond to the treatment, they will not reappear. However, new veins may appear at the same rate as before.
Injections are done using a very fine needle directly into the vein. Patients may feel mild discomfort and cramping for one or two minutes especially if larger veins are injected. It is not uncommon for the areas to feel itchy during and post-treatment sometimes lasting up to two days. Bruising may occur around the injection sites.
Other side effects include:
- Larger veins that have been injected may become lumpy and hard and may require several months to dissolve and fade.
- Brown lines or spots may appear at the vein site. In most cases, they disappear within three to six months.
- Neovascularization, or the temporary development of new, tiny blood vessels may occur at the site of sclerotherapy treatment. These tiny veins can appear days or weeks after the procedure but should fade within three to twelve months without further treatment.
For veins larger than 4mm, the usual sclerotherapy injection may not be as effective. With these veins, Foam Sclerotherapy has shown a higher success rate. For more information on foam sclerotherapy, click here.
Instructions before and after your sclerotherapy procedure can be found here.
Compression usually in the form of stockings serves several important functions. Compression of the treated vessel decreases the chance of the vessel reopening, decreases the incidence of hyperpigmentation, and decreases the inflammation that can cause matting, increases blood flow which thereby decreases the risk of deep vein thrombosis. Immediately after treatment, compression helps the injected vein walls to stick together which leads to increased wall damage. Research has shown that wearing the hose will lead to a better result with less unwanted side effects.