Sclerotherapy of Varicose Veins and Spider Veins

What is Sclerotherapy of Varicose Veins and Spider Veins?

Sclerotherapy is a minimally invasive treatment used to treat varicose and spider veins. The procedure involves the injection of a solution directly into the affected veins, causing them to shrink and eventually disappear.

What are some common uses of the procedure?

Sclerotherapy is used to improve the cosmetic appearance of spider veins and to relieve some of the symptoms associated with spider veins, including aching, burning, swelling and night cramps. It is the primary treatment for small varicose veins in the legs.

How should I prepare?

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred to as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.

You may be asked to stop taking iron supplements.

Also inform your doctor about recent illnesses or other medical conditions.

Ask your doctor about antibiotic medications you may be taking or ask for safe guidelines for discontinuing these medications.

No lotion should be applied to legs before or after sclerotherapy.

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

You may want to bring a pair of shorts to wear during the procedure.

What does the equipment look like?

The procedure uses a very fine, thin needle to inject a sterile sclerosing solution into the small veins.

How does the procedure work?

When the sclerosing solution is injected directly into the spider or varicose veins, it irritates the lining of vein, which causes it to swell and stick together. Over time, the vessel turns into scar tissue that fades from view.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.

Using a very fine needle, your interventional radiologist will inject the vein-dissolving solution into the varicose and spider veins. As the procedure continues, you will feel small needle sticks and possibly a mild burning sensation. The number of veins treated in one session varies, and depends on the size and location of the veins.

The procedure is usually completed within 30 to 45 minutes.

What will I experience during and after the procedure?

You may experience a cramping sensation for one to two minutes when larger varicose veins are injected.

After the treatment you will be instructed to wear support hosiery or wraps to "compress" the treated vessels.

You may experience certain side effects after sclerotherapy. Larger injected varicose veins may become lumpy and/or hard for several months before resolving. Raised red areas may appear at the injection sites and should disappear within a few days. Brown lines or spots on the skin may be seen at the injection sites. In most cases, they disappear within three to six months, but can be permanent about five percent of the time. Bruising may occur around the injection site and can last several days or weeks.

In general, spider veins respond to sclerotherapy 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 over time, and if needed, you may return for additional injections.

Who interprets the results and how do I get them?

The interventional radiologist can advise you as to whether the procedure was a technical success when it is completed.

Your interventional radiologist may recommend a follow-up visit after your procedure or treatment is complete.

The visit may include a physical check-up, imaging procedure(s) and blood or other lab tests. During your follow-up visit, you may discuss with your doctor any changes or side effects you have experienced since your procedure or treatment.

What are the benefits vs. risks?

Benefits

• Each sclerotherapy session typically results in elimination of 50 to 80 percent of the injected veins.

Risks

• Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• Risks include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing solution and skin injury that could leave a small but permanent scar.

What are the limitations of Sclerotherapy?

Large varicose veins do not respond as well as small ones to sclerotherapy. A few (less than 10 percent) of people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions or a different method, such as cutaneous laser therapy, may be attempted.

You will not be able to undergo sclerotherapy treatment if you are pregnant, breastfeeding, or are bedridden. You must wait at least three months after giving birth before you can be considered for this procedure.

Often, phlebectomy is used with a more comprehensive treatment plan, including additional procedures such as endovenous catheter ablation that use radiofrequency or laser energy.

Patients should discuss their individualized treatment plan with their interventional radiologist.