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Sclerotherapy

Sclerotherapy is used to correct unwanted and unsightly veins both large and small in size. From the small purple veins to the largest ropey varicose veins, sclerotherapy is a procedure in which a sclerosing solution is directly injected into the vein with a very small needle followed by compression at the site of injection. This causes the vein to close and the body naturally removes it.

Sclerotherapy has been used for spider vein removal since the 1930's, and before that for larger veins. The sclerosing solution used at Madison and Shoals Vein Centers is Sodium Tetradecy Sulfate (STS) or Polidocanol. One of these is used for larger varicose veins and the other is reserved for the small spider veins. It is injected directly into the blood vessel with a very fine needle (30 ga.). The solution irritates the lining of the vessel and causes the vessel to close. Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable.

When you arrive for your session, you should bring a comfortable pair of shorts and do not apply lotion to your legs that morning. Do not have a dark tan or a recent "spray on" tan application as these make the veins much more difficult to see.

A typical sclerotherapy session is relatively quick, lasting only about 25-30 minutes. After changing into shorts, your legs may be photographed for your medical records. You will be asked to lie down on the examination table and the skin over your spider veins will be cleaned with an antiseptic solution. With the lights turned down, we will use the VeinLite to locate the feeder vein (reticular vein) that is feeding the veins that you can see on top of your skin (spider veins). We will begin injecting the sclerosing agent into the affected veins. After the reticular veins have been injected, we will turn up the lights and inject the spider veins (telangectasias) using a microscopic needle. Magnification surgical loop glasses also help ensure that the process is completed with maximum precision.

During the procedure, you may listen to music, read, or just talk with the staff. You will be asked to shift positions a few times during the process. As the procedure continues, you will feel small needle sticks and possibly a mild burning sensation or itching that will resolve momentarily. However, the needle used is so thin and the sclerosing solution is so mild that pain is usually minimal.

After Your Treatment

Your doctor will usually recommend a period of several days of compression stockings. Normal activities are resumed immediately in most cases. It's not uncommon to experience some minimal discomfort in the legs for the first day or two after the injections and using Ibuprofen is recommended.

You should be aware that your treated veins will look worse before they begin to look better. You will notice bruising and reddish areas at the injection sites. The bruises will diminish within one month. In many cases, there may be some residual brownish pigmentation which may take up to a year or more to fade. To reduce the risk of these brownish spots, your doctor may ask you to return for an office visit several weeks after your sclerotherapy session to check the injection sites. Often some of the larger treated veins may contain small amounts of "trapped blood" (NOT blood clots) which can be drained with little discomfort in the office. This will promote healing and decrease the possibility of brownish staining or hemosiderin deposits.

Although you probably won't want to wear any leg-baring fashions for about two to four weeks, your activity will not be significantly limited in any other way from sclerotherapy treatment. You will be encouraged to walk to prevent clots from forming in the deep veins of the legs. However, during the period of time to complete your treatment program, prolonged sitting and standing should be avoided, as should squatting, heavy weight lifting and "pounding" type exercises, including jogging. Tanning beds should be avoided as should hot baths and/or showers.

With our use of the VeinLite, we are able to locate the underlying vein that "feeds" the veins that you can see on top of your legs. This is the key to a successful sclerotherapy session. Without the eradication of the underlying vein that is continually pumping blood into the smaller spider vein the troublesome vein will return over and over with you putting out money time and time again.

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. Pain is momentary and feels much like a mosquito bite. Any stinging or irritation resolves rapidly after support hose are applied and hive-like reactions usually go away within 10 to 15 minutes after injection.

Red, raised areas at the sites of injection are normal and will resolve usually within a day or two.
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 called blushing or matting. About one-third of patients develop blushing especially on the thighs. Most disappear by themselves, some need additional injection or veinwave treatments, 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 physician immediately.
Temporary bruises. Bruises usually occur after sclerotherapy and are most likely related to the thinness of blood vessel walls. They usually disappear in a few weeks.

Allergic reactions to sclerosing solutions. Although such reactions are uncommon, they can be treated. Usually the patient is having an allergy attack at the time the sclerotherapy is done. We will reschedule your session if you have actively running nose, coughing or any indication of allergies until they subside.
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.

Tender lumps in injected vessels. This is coagulated blood and is not dangerous. If the areas are sufficiently large, the physician may aspirate the vein and express the contents to promote rapid healing. This is usually done three to four weeks after the initial injections and often occurs after injection of larger varicose veins. It is not permanent and will usually resolve after several months.

REMEMBER: Sclerotherapy treatment goals are VEIN REDUCTION and not VEIN PERFECTION. It is difficult to remove ALL of the small spider veins. Treatment results vary from patient to patient and are dependent on multiple factors. These factors include age, skin type, size of veins treated, smoking, etc.