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Sclerotherapy

Sclerotherapy is a “non-surgical” method for the treatment of unwanted leg veins.

Using a very fine needle, the physician injects a solution “sclerosing agent” into the veins that causes them to contract and eventual disappear. The injected veins become inflamed, blood is then unable to flow through them and ultimately, the body absorbs these non-functioning vessels.

Sclerotherapy is most commonly used for treatment of unwanted, visible spider veins and varicose veins.

Spider veins are tiny red or blue veins that can appear anywhere on the body but occur most commonly on the legs.

Varicose veins are generally larger veins that are usually raised above the skin’s surface. Varicose veins can sometimes cause aching legs and swelling of the ankles. They can also be associated with burning, stinging, throbbing, restless legs and leg cramps. These blood vessel abnormalities commonly occur in families, which suggests they may be an inherited condition.

They more often affect women, commonly appearing during pregnancy. It is also believed that prolonged standing may be a factor in the development of these abnormalities, along with previous injury or bruising. Obesity, tallness and oestrogens (as in the oral contraceptive pill and hormone replacement therapy) are all considered minor risk factors.

With sclerotherapy, the doctor will use very fine needles to inject the sclerosing solution into the blood vessels. Multiple vessels can be injected during one treatment session. The injections usually cause minimal discomfort although some people might experience a slight to moderate burning sensation immediately after the injection.

The veins may require a number of repeated injections over a period of weeks to ensure they are fully sclerosed and fade from view. A compression stocking is usually applied following treatment.

Here is a video on sclerotherapy:

Does Sclerotherapy work for everyone?

The majority of persons who have sclerotherapy will see good improvement. Unfortunately, there is no guarantee that sclerotherapy will be effective in every case. Approximately 10% of patients who undergo sclerotherapy have poor-to-fair results. (“Poor results” means that the veins have not totally disappeared after six treatments.)

How many treatments will I need?

The number of treatments needed to clear or improve the condition differs from patient-to-patient depending on the extents of varicose and spider veins present. Six or more treatments may be needed. The average is three to four treatments. However, there is no guarantee that multiple treatments will clear all veins.

While sclerotherapy is safe and highly effective,  more than one treatment, is usually required to clear or improve unsightly veins to a patient’s satisfaction. A small minority of patients do not improve even after six treatments. In rare instances the patient’s condition may worsen after treatment.

What are the most common side effects?

  • Itching – depending upon the type of solution used, you may experience mild itching along the vein route. The itching normally lasts one to two hours but may persist for a day or so.
  • Bruising – lasts  from one to several weeks. Use of support hose may be recommended and avoidance of alcohol and anticoagulant medication for 72 hours prior to each treatment session may minimise effect.
  • Transient Hyperpigmentation – approximately 10% of patients who undergo sclerotherapy notice a discolouration of light brown streaks after treatment. In almost every patient, the veins become darker immediately after the procedure (but then go away). In rare instances, this darkening of the vein may persist for 4 to 12 months.
  • Pain – a few patients may experience moderate to severe pain and some bruising, usually at the site of the injection. The veins may be tender to the touch after treatment and an uncomfortable sensation may run along the vein route. This pain is usually temporary, in most cases lasting 1 to at most 7 days.
  • Sloughing – occurs in less than 1% of patients who receives sclerotherapy. Sloughing consists of a small ulceration at the injection site, which heals slowly over 1 to 2 months. A blister may form, open and become ulcerated. The scar that follows should return to normal colour. This usually represents injection into or near a small artery and is not preventable.
  • Allergic Reactions – very rarely a patient may have an allergic retain to the sclerosing agent used. The risk of an allergic retain is greater in patients who have a history of allergies.
  • Blood accumulation in treated vessels – this may present as a tender bump at the treatment site. The use of prescribed compression hosiery will minimise this possibility (especially when treating Reticular Veins).
  • Telanglectatic Matting – refers to the development of tiny new blood vessels in the treated area. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 18% of women on oestrogen therapy and in 2% to 4% of all patients.
  • Ankle Swelling – may occur after treatment of blood vessels in the foot or ankle. It usually resolves in a few days and is lessened by wearing the prescribed support stockings.
  • Phlebitis – is a very rare complication seen in approximately 1 out of every 1,000 patients treated for varicose veins greater than 3 to 4mm in diameter. The possible dangers of phlebitis include a pulmonary embolus or blood clot, which travels to the lungs and post-phlebitis syndrome, which can result in permanent swelling of the legs.

What are the possible complications if I do not have sclerotherapy?

In cases of large varicose veins, greater than 3 to 4mm in diameter, spontaneous phlebitis and/or thrombosis may occur with the associated risk of pulmonary emboli (a blockage of the main artery of the lung). Additionally large skin ulcerations may develop in the ankle region of patients with long-standing varicose veins with underlying venous insufficiency. Rarely, these ulcers may haemorrhage or become cancerous.

Are there other procedures to treat varicose veins and telanglectasias? What are the side effects?

Because varicose and telanglectatic leg veins are not life-threatening conditions, treatment is not mandatory in every patient. Some patients may get adequate relief of symptoms from wearing graduated supporting stockings. Ambulatory Phlebectomy is a procedure where certain types of veins can be removed through small surgical incisions. The complications of this procedure are similar to sclerotherapy with the addition of small surgical scars.

Vein stripping and/or ligation may also be utilised to treat large varicose veins. This may require a hospital stay and is performed while the patient is under general anaesthesia. Risks of vein stripping and/or ligation include permanent nerve paralysis in up to 30% of patients, possible pulmonary emboli, infection and permanent scarring. General anaesthesia has some associated risks, including paralysis, brain damage and death.

Other types of procedure to treat telangiectasias?

Laser and Filtered Fish-Lamp therapies can be utilised to treat small spider veins less than 1mm in size, which are more difficult to treat with conventional sclerotherapy injections.

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