Sclerotherapy

Sclerotherapy is an injection treatment used to eliminate small to medium size varicose veins of the lower extremities. Spider veins are superficial telangiectasias, tiny vessels that are purple in color. The majority of these veins present a cosmetic problem.

About the Treatment

The number of treatments needed varies from patient to patient depending on the type, size and quantity of veins to be treated. Varicose veins and "spider" veins may require multiple injection sessions. Treatments are usually scheduled every four to six weeks. It is important to realize that the best results require patience. It takes time for your body to respond to the injections. It is important to follow the post-treatment instructions to optimize your results. Your body will continue to heal and "fade" injection sites for months after treatment.

What to Expect:

Photographs will be taken before treatment is initiated. This helps to monitor your progress. After the vein is damaged the body needs time to heal. Most people will notice a significant improvement approximately four weeks after their initial treatment. Maximal improvement often takes several months and several treatments. There is no guarantee sclerotherapy will be effective in every case. Some veins and areas will need to be retreated. Recurrence of the same vein treated rarely occurs with proper injection technique and compliance with post treatment instructions. Periodic reevaluations are encouraged so that any new veins that develop can be injected before they become too large or too numerous.

Common Side Effects:

• Itching -You may experience itching around the area injected. If this occurs, it is usually mild and lasts from a few hours up to 24 hours.
  
• Hyperpigmentation - A light brown discoloration of the skin may develop along the vein in the area injected. Approximately 20% of patients are treated note discoloration of the vein being treated. The hyperpigmentation usually fades in a couple of weeks, but may take several months to a year to totally resolve. There is one-percent incidence of hyperpigmentation continuing after one year.
  
  A small amount of blood may become trapped and hardened in the vein when injecting varicose veins or some "spider" vein complexes. This may feel like a knot or cord and it may look dark blue or bruised. You may need to return before your next treatment so that this area can be drained to remove the trapped blood. This will reduce the hyperpigmentation that can occur. The chance of this occurring can be decreased with proper compression of the vein and use of compression hose after your treatment.
  
• Telangiectatic matting - The formation of new, fine "spider" veins in the area injected occurs in approximately 10% of patients injected. The exact reason for this occurring is unknown. If untreated, the matting usually resolves in three to twelve months, but very rarely it can be permanent. If the matting does not fade it can be re-injected or treated with a laser. In some instances, matting may persist.
  
• Pain - It is common to have some tenderness at the injected site. Injection of the sclerosing agent causes mild discomfort, but is usually well tolerated by most patients. The discomfort is temporary, lasting a few days. Acetaminophen (Tylenol) can be used if needed, according to product directions.
  
• Bruising - May occur at the injection site. Bruising may be minimized by avoiding Aspirin and NSAID products for seven days before and after each treatment session.

Rare Side Effects:

• Ulceration at Injection Site - Very rarely a small ulcer will occur at the site where the vein is injected. An ulcer can take four to six weeks to completely heal. A small scar may result.
  
• Allergic Reaction -There is a very rare incidence of an allergic reaction to the solution injected. You will be observed for such reactions and will be treated appropriately should it occur. Please inform us of any allergic history.
  
• Pulmonary Embolus/Deep Vein Thrombosis - A blood clot to the lungs or a blood clot in the deep vein. In the medical literature there is an extraordinarily low incidence of this complication when treating superficial veins.

Alternatives to Sclerotherapy

You may choose no therapy. The existing varicose and "spider" veins may progress and new veins may form. You should be reevaluated periodically to monitor your condition for changes.

You may choose to only wear compression support hose (if this is an appropriate treatment for your problem). Compression hose promote venous blood return to the heart. If support hose are worn faithfully symptoms such as aching, heaviness and tiredness are often alleviated. They also may help prevent the progression and formation of varicose and "spider" veins.

Vein stripping and/or ligation may be appropriate to treat some patients with larger varicose veins. Laser therapy may be and option if you have "spider" veins. Your doctor will discuss these alternatives with you.

Before & After

  
Before and 3 months after 4 treatments
Courtesy of Marc Troxler, MD
Arlesheim, Switzerland