Sclerotherapy

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What is Sclerotherapy?

Sclerotherapy is a procedure used to treat spider veins and varicose veins. It has been used for spider veins since the 1930's, and before that for larger veins. A small amount of sclerosing solution is injected directly into the blood vessel with a very fine needle. The solution irritates the lining of the vessel causing it to swell, stick together, and then heal closed. Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable. A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. A number of vessels can be injected in any one-treatment session.

Occasionally, larger varicose veins are connected to them. In such cases, these vessels should be treated along with spider veins. This can be done by sclerotherapy, or the latest techniques using endovenous laser, stripping, ligation, or radiofrequency. Great advances have been made in the use of ultrasound to guide the injection of sclerosing solutions. Ultrasound may be used to treat large vessels, as well.

How successful is sclerotherapy?

After several treatments, most patients can expect an 80 - 90 percent improvement. Fading will gradually occur over months. Disappearance of treated spider veins is usually achieved, but similar veins may appear in the same general area. Are there side effects to sclerotherapy?

There are some possible side effects. They include:

  • Stinging or pain at the sites of injection, swelling of the ankles or feet, or muscle cramps. This usually occurs when hypertonic saline solution is used. Hive-like reactions usually go away within 10 to 15 minutes after injection.
  • Red, raised areas at the sites of injection. These are similar to hives and the response should disappear within a day or so.
  • Brown lines or spots on the skin at the sites of treated blood vessels. Darkened areas may result when blood escapes from treated veins and are probably formed from iron in the blood. These dark areas occur more often in patients who have larger veins treated or those patients that tan easily. In most cases, they disappear within a year, but they may last longer.
  • Development of groups of fine red blood vessels near the sites of injection of larger vessels. About one-third of patients develop groups of vessels especially on the thighs. Most disappear by themselves, some need additional injection treatments or laser therapy, a few may last.
  • Small, painful ulcers at treatment sites either immediately or within a few days of injection. These occur when some of the solution escapes into the surrounding skin or enters a small artery at the treatment site and can be successfully treated, but it is necessary to inform the dermatologist immediately.
  • Temporary bruises. Bruises usually occur after laser treatments and are probably related to the thinness of blood vessel walls. They usually disappear in a few weeks. Occasionally, bruising is seen with sclerotherapy.
  • Allergic reactions to sclerosing solutions. Although such reactions are uncommon, they can be treated. Inform your dermatologist immediately.
  • Inflammation of treated blood vessels. This is very unusual but when it occurs, it is treated with medications such as aspirin, compression, antibiotics, or heat.
  • Lumps in injected vessels. This is coagulated blood and is not dangerous. The dermatologist may drain the blood from these areas a few weeks after injection.
  • Burning with discoloration of the skin.

Will treated veins recur?

Large veins may recur even after surgical procedures. Spider veins may also recur. It may seem that a previously injected vessel has recurred when, in fact, a new spider vein has appeared in the same area.

Is a history of blood clots in the lungs or legs a reason to avoid therapy?

Not necessarily, but the procedure must be done with caution to lessen the risk of blood clots.

Are there other treatment methods?

Ambulatory phlebectomy, developed by dermatologists, is a method using small punctures to remove varicose veins. The methods for larger varicose veins such as endovenous radiofrequency, and endovenous laser, may be used in combination.

What do I do after treatments?

Dermatologists may differ in their treatment instructions to patients. Most advise their patients to "clear" the sclerosing solution out of the circulation. Patients are instructed to walk following the procedure.

Some physicians bandage the injected areas and instruct patients to "compress" the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin, and reduce the development of dark spots. It also may reduce the number of treatments necessary, and the possibility of recurrence. Others put tape dressings on the areas and do not use compression unless the veins are large or in special locations.

Between treatments, many dermatologists recommend the use of compression or support hose. This may be recommended for people who spend a lot of time on their feet, or work in a standing occupation.

Will insurance cover the treatment of unwanted blood vessels?

Insurance rarely covers treatment of spider veins but may sometimes cover larger vein treatment. If the treatment is solely for cosmetic reasons, it may not be covered. To get the procedure covered for larger varicose veins, a second opinion, laboratory studies, or photographs may be required by insurance companies before treatment is started. Discuss the costs with your dermatologist before deciding on treatment.