What is sclerotherapy?
Sclerotherapy is a well-proven medical procedure that has been used since the early 1900s and is the most common treatment for both spider veins and varicose veins. During sclerotherapy the physician injects a solution directly into the affected vein. The solution irritates the lining of the vessel causing it to swell and stick together. This stops the flow of blood and the vein turns into scar tissue that in a few weeks fades from sight.
Sclerotherapy is more than a cosmetic procedure since varicose veins can cause many medical problems such as blood clots, skin breakdown, ulcerations and occasionally bleeding when a vein erodes through the skin. Sclerotherapy has a success rate of approximately 90%.
How is sclerotherapy done?
Sclerotherapy is a common treatment for small (spider veins) and medium size (reticular) veins. Sclerotherapy is usually safe especially when performed by a vascular specialist. After the area to be treated is cleaned, a tiny needle is used to inject the veins with a solution (called a sclerosant) that irritates the lining of the vein. In response, the veins collapse and are reabsorbed. The surface veins are no longer visible. Depending on the size and location of the veins, different types and strengths of sclerosants are used. With this procedure, veins can be dealt with at an early stage, helping to prevent further complications. If a vein has eroded through the skin and bled, it is usually injected with sclerosant to prevent further bleeding while you are undergoing workup to determine a more permanent solution to your problem.
The procedure, performed in the doctor’s office, requires no anesthesia. You will have a compression wrap or wear your support stockings. You will elevate your leg higher than your heart the rest of the day except for once each hour to walk five minutes and then resume elevation. Beginning the next day you can usually resume your normal activities–just no running, no high-impact workout and no weightlifting.
Modern advances in sclerotherapy technique are ultrasound guided sclerotherapy and foam sclerotherapy.
Ultrasound guided sclerotherapy
Ultrasound guided sclerotherapy is a procedure used to treat medium to large varicose veins. Ultrasound guided sclerotherapy represents a major advancement in vein treatment because the ultrasound technology enables doctors to find and inject veins that are not visible on the surface.
In the past, the only way to treat medium to large varicose veins was with surgery and more recently endovenous laser or radiofrequency ablation. Ultrasound guided sclerotherapy enables the doctor to visualize on a monitor deep-seated dilated veins that are not otherwise visible in their entire length on the surface of the skin. The veins will be mapped out to determine precisely which veins need injections and which veins are best left alone. Using duplex ultrasound, doctors can determine how many injections are required.
Ultrasound-guided sclerotherapy has been used in Great Britain for a few years instead of stripping, endovenous laser or radiofrequency ablation, but it requires on the average at least 2.9 treatment sessions.
Ultrasound guided sclerotherapy is particularly advantageous for those who have already undergone varicose vein surgery once and have recurring veins. Using ultrasound, the doctor can pinpoint the exact cause of the recurring veins.
Foam sclerotherapy is a technique that involves injecting “foamed sclerosant drugs” within a blood vessel using a syringe. The sclerosing agents are mixed with air or a physiological gas in a syringe or by using mechanical pumps. This increases the surface area of the sclerosant. The foam sclerosant drug has a more desired effect than the liquid one in causing thickening of the vessel wall and sealing off the blood flow because it does not mix with the blood in the vessel and, in fact, displaces it and thus avoids dilution of the drug and causing maximal sclerosant action because it is on the surface of the gas bubbles which insures that the chemical is in contact with all the walls and is undiluted. It is, therefore, useful for longer and larger veins. Experts in foam sclerotherapy have created toothpaste-like thick foam for their injections, which has revolutionized the non-surgical treatment.
How successful is sclerotherapy?
It is estimated that as many as 50 to 80 percent of the veins injected are eliminated with each session. Of those people treated with sclerotherapy, only less than 10 percent do not respond at all and in these instances a different solution or a different method, such as laser therapy, may be tried.
Usually spider veins respond to treatment in 3 to 6 weeks and larger veins respond in 3 to 4 months. Usually sclerosed veins do not reappear. Some patients may have new veins appear over a period of time in which case they can return for injections.
How do I know if I’m a candidate for sclerotherapy?
Before the procedure, you will have an initial consultation with a vascular specialist who will do a thorough assessment of you and your veins to determine if sclerotherapy is the best treatment for you.
You are not eligible for sclerotherapy if you are pregnant, breastfeeding or bedridden. If you have just had a baby, it is recommended that an appropriate period of time lapse after delivery before you can be considered for this procedure and the vascular specialist will discuss this with you. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be determined on an individual basis and will depend on the extremity and the cause of the clot.
What if I need my veins later in life?
Veins that are potentially usable for future surgical bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery) will generally not be considered for injection, unless they are already deemed unusable. Every attempt possible will be made to save any vein that is stil usable for bypass procedures.
What are the risks?
As with any surgery there will always be side effects. The more common side effects that may occur at the site of the injection include:
- Raised red areas
- Small skin sores
- Multiple tiny red blood vessels
- Darkened skin in the form of lines or spots overlying the vein that was injected. Many times large, dark veins after sclerotherapy will be drained by needle 7 to 14 days after the procedure so that the breakdown of red blood cells does not stain the skin. These side effects usually go away within a few days. Dark pigmented areas may take a few months but this can be largely improved or resolved with Intense Pulsed Light (PhotoDerm) treatments.
These side effects usually go away on their own within a few days to weeks.
Other side effects that rarely develop include:
- Inflammation within five inches of the groin
- Sudden onset of a swollen leg
- Formation of small ulcers at the injection site
- Red streaking, especially in the groin area
- On rare occasion there can be sudden temporary loss of vision or transient-type ischemic attacks. For this reason, only a limited amount of foam sclerosant will be used in any one sitting. We know you would like to have all your veins taken care of at one time; but if you have many large veins, treatment of each leg may have to be done in two or three sessions.
What can I expect after surgery?
You will be instructed to wear support stockings or compression wraps to compress the treated vessels. Your vascular specialist will advise you of the exact amount of support you will need and where these can be purchased as support stockings purchased from a department store are not adequate if a heavy compression stocking is prescribed. You will wear your support stockings around-the-clock except to shower for the first 7 days. You will usually elevate your leg higher than your heart for the first 12 hours except to get up and walk 5 to 10 minutes each hour.
If you have small spider veins, many people return to their normal activities on the same day, but your doctor may advise you to have someone drive you home after the procedure so you can keep your leg elevated. Your doctor will probably advise you to avoid strenuous exercise for two weeks after the procedure. You will also want to avoid sun exposure to the treated areas during that time. The inflammation caused by the injections combined with sun exposure can lead to dark spots on your skin, especially if you already have a dark skin tone.
You can usually expect to see results in three to six weeks. Larger veins may require three to four months. Treated veins generally do not come back but new veins may appear. Your doctor will most likely have you return the next day for follow-up. You will then be scheduled a return visit in about 7 to 14 days after your procedure to check the succes of the procedure and to see if any old dark blood needs to be drained before it pigments your skin. Following that you will need to return in about one month to check the procedure’s success and decide whether further sessions are needed.
How much does it cost and will insurance cover it?
Costs vary depending on how many treatments you require. Sclerotherapy is usually considered a cosmetic procedure and is not covered by insurance. However, some symptomatic veins may qualify for insurance coverage and your insurance company may request a letter from your vascular specialist before a determination can be made. This is particularly true if your insurance company would not approve everything that needed to be done with the first procedure. Sometimes some of the large tributary veins are approved for treatment only after it has been documented that your pain has not improved enough after 6 to 12 weeks.
We hope the information on these pages is both informative and helpful, but it is intended for education only. Please do note that no web site, no matter how much information is shared, can replace a consultation with your doctor and a vascular specialist. Medical technology and treatment are continually improving and evolving so before making any decision on treatment, it is always advisable to see your doctor first for a comprehensive evaluation of your vascular disease and other medical conditions.
At the Vascular Center of Wichita Falls, we work closely with your other physicians. If you have concerns about your arteries or veins, contact us. A referral is not necessary to make an appointment.