Sclerotherapy is the “gold standard” of treatment for most varicose veins and spider veins of the legs. The procedure involves the injection of various solutions with extremely small needles into the targeted veins. The solution irritates the vessel wall lining, leading to an inflammatory reaction that seals the veins and ultimately leads to the absorption and disappearance of the treated veins.
Classically, hypertonic saline was used for many years as a sclerosing agent but had a great risk of skin ulceration. Newer FDA-approved sclerosing agents are now used that have a minimal risk of ulceration. These include Asclera® (polidocanol), and glycerin. All sclerosing agents create an inflammatory reaction inside the vein and this inflammation can lead to hyperpigmentation (browning) of the overlying skin, telangiectatic matting or formation of new very tiny red blood vessels in the area treated, or even ulceration or erosion of the overlying skin. These risks are minimized with appropriate compression after the procedure.
Asclera® (polidocanol), FDA-approved in 2010, can be used as liquid or a foam to treat small blue and purple/red veins. The active molecule of polidocanol has an anesthetic effect upon injection, making this procedure very comfortable. In clinical trials, polidocanol had superior effectiveness to other sclerosing agents and a decreased incidence of side effects.
Glycerin is a sugar solution that is used to treat tiny red veins. It has a very low incidence of side effects—hyperpigmentation, ulceration, and telangiectatic matting are unlikely to occur with this sclerosing agent. It can be used to treat the matting that may appear with other solutions.
What happens during the procedure?
Sclerotherapy is a short, comfortable, in-office procedure that can take 30-60 minutes to complete, depending on how many veins will be treated. The newer solutions used do not burn and the smallest possible needle will be used for injection. You can expect to feel a cool rushing sensation in the treated area when the solution is injected correctly.
How many sclerotherapy sessions will I need?
The number of sessions is determined by the severity of the abnormal leg veins and on individual responses to treatment. On average, 2-4 treatments are needed at least 6-8 weeks apart. A single session may improve the appearance of veins by approximately 40%. As sclerotherapy treatment does not remove the underlying tendency of patients with spider veins and varicose veins to develop new, abnormal veins, touch-up treatments may be required periodically.
How do I care for my legs after sclerotherapy treatment?
After sclerotherapy is complete, the nursing staff will apply a pressure dressing the treated areas. Then they will help you put on your graded compression stockings. It is important to purchase these stockings prior to treatment a bring one pair with you to your session. You can contact our office for recommendations as to which stockings to purchase. Clinical studies have shown that wearing compression hose immediately following sclerotherapy treatment decreases the incidence of side effects, particularly hyper pigmentation and telangiectatic matting, and promotes more effective clearance of the treated veins. We encourage you to wear your compression stockings for 7 days straight, 24 hours a day—even when sleeping. You must wear them for the first 24 hours straight so please shower before your treatment. After 24 hours, you can only take them off for showering. Compression therapy during this week is critical to avoid side effects and get better clearance of your veins. After 1 week, we encourage you to continue wearing your stockings for the next 3 weeks during the day only. Patients are encouraged to walk immediately following treatment, and every day thereafter to promote healing.
When do my veins improve and how long does sclerotherapy last?
Immediately post treatment, your veins will appear red and inflamed. Results from sclerotherapy can take approximately 2 to 3 months to occur. You will likely need more than one treatment to achieve full clearance.
What are the possible side effects associated with sclerotherapy?
Sclerotherapy is well-tolerated with minimal side effects that and resolve over time. The most common immediate side effects include itching, bruising, mild pain and swelling in the treatment area. These resolve over several days to weeks. Hyperpigmentation and new small vessel formation or matting can be seen later, resolve with time, and are minimized by wearing compression stockings as described above.
Is sclerotherapy treatment contraindicated for any individuals?
Yes. Patients with sensitivity or allergy to any of the sclerosing solutions, or their inactive ingredients should not be treated. Patients with a known, symptomatic heart condition called patent foramen ovale (PFO) have a relative contraindication to treatment with the foamed version of polidocanol.