Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations (vascular malformations) and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations. In adults, sclerotherapy is often used to treat spider veins, smaller varicose veins, hemorrhoids and hydroceles.
Sclerotherapy is one method, along with surgery, radiofrequency and laser ablation, for treatment of spider veins, occasionally varicose veins, and venous malformations. In ultrasound-guided sclerotherapy, ultrasound is used to visualize the underlying vein so the physician can deliver and monitor the injection. Sclerotherapy often takes place under ultrasound guidance after venous abnormalities have been diagnosed with duplex ultrasound. Sclerotherapy under ultrasound guidance and using microfoam sclerosants has been shown to be effective in controlling reflux from the sapheno-femoral and sapheno-popliteal junctions. However, some authors believe that sclerotherapy is not suitable for veins with reflux from the greater or lesser saphenous junction, or for veins with axial reflux.
Candidates for Sclerotherapy
Prior to sclerotherapy, you will have an initial consultation with a dermatologist or vascular medicine specialist who will decide if you’re a good candidate for the procedure.
You are not eligible if you are pregnant. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be decided on an individual basis, and will depend on the overall health of the area needing treatment as well as the reason for the clot.
Veins that are potentially usable for future heart bypass surgery will generally not be considered for sclerotherapy, unless they are already deemed unusable.
How Sclerotherapy Is Done
In most cases of sclerotherapy, the salt solution is injected through a very fine needle directly into the vein. At this point, you may experience mild discomfort and cramping for one to two minutes, especially when larger veins are injected. The procedure itself takes approximately 15 to 30 minutes.
The number of veins injected in one session depends on the size and location of the veins, as well as the general medical condition of the patient.
Sclerotherapy is performed in the doctor’s office by a dermatologist or a surgeon and requires that you do not do any aerobic activity for a few days after the procedure.
What to Do Before Sclerotherapy
Prior to sclerotherapy, you should avoid certain medications. Talk to your doctor about all medicines (including over-the-counter drugs, herbs, and dietary supplements) you are taking. If you need to take an antibiotic before sclerotherapy, contact your doctor. No lotion should be applied to the legs before the procedure.
Some doctors recommend avoiding aspirin, ibuprofen (such as Advil, Motrin, and Nuprin) or other anti-inflammatory drugs for 48-72 hours before sclerotherapy. Tylenol, however, should not affect this procedure.
What Happens After Sclerotherapy
After sclerotherapy you will be able to drive yourself home and resume your regular daily activities. Walking is encouraged.
You will be instructed to wear support hosiery to “compress” the treated vessels. If you have compression hosiery from previous treatments, you are encouraged to bring them with you to be certain they still have adequate compression. Department store support stockings will not be adequate if a heavy compression stocking is needed. Your doctor’s office can recommend where to purchase heavy compression stockings.
Following the injections, avoid aspirin, ibuprofen, or other anti-inflammatory drugs for at least 48 hours. Tylenol may be used if needed.
Also, you should avoid the following for 48 hours after treatment:
- Hot baths
- Hot compresses
- Whirlpools or saunas
- Direct exposure to sunlight
Showers are permitted, but the water should be cooler than usual. The injection sites may be washed with a mild soap and tepid water.
Studies have shown that as many as 50%-80% of injected veins may be eliminated with each session of sclerotherapy. Less than 10% of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions can be tried. Although this procedure works for most patients, there are no guarantees for success.
In general, spider veins respond 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 at the same rate as before. If needed, you may return for injections.
Insurance Coverage for Sclerotherapy
Insurance coverage for sclerotherapy varies. If your varicose veins are causing medical problems such as pain or chronic swelling, your insurance may offer reimbursement. If you are pursuing sclerotherapy for cosmetic purposes only, your insurance carrier most likely will not provide coverage. You should discuss your concerns with your doctor. If you have questions, call your insurance company, which may request a letter from your doctor concerning the nature of your treatment and medical necessity.
Is sclerotherapy safe?
All medical procedures have risks that should be considered carefully prior to embarking on a particular treatment. Since sclerotherapy is frequently used to treat cosmetic problems, untoward and dangerous side effects are fully explained to the patient.
Does sclerotherapy hurt?
Because this procedure requires injections through the skin, it is not a painless procedure. Certain chemicals that are injected (sclerosants) are more likely to cause pain than others. If the sclerosant is deposited outside the vein inadvertently, this is often more painful.
Is sclerotherapy an effective treatment for varicose veins and spider veins?
Sclerotherapy is an effective technique to obliterate or collapse veins. Other techniques include surgical removal of the offending vein, endovenous laser destruction (fiberoptic-transmitted laser light) and, for very small vessels, percutanous laser light or intense pulsed-light exposure are also effective.
If the sclerosant is injected properly into the vein, there is no damage to the surrounding skin, but if it is injected outside the vein, tissue necrosis and scarring can result. Skin necrosis, whilst rare, can be cosmetically “potentially devastating”, and may take months to heal. It is very rare when small amounts of dilute (<0.25%) sodium tetradecyl sulfate (STS) is used, but has been seen when higher concentrations (3%) are used. Blanching of the skin often occurs when STS is injected into arterioles (small artery branches). Telangiectatic matting, or the development of tiny red vessels, is unpredictable and usually must be treated with repeat sclerotherapy or laser.
Most complications occur due to an intense inflammatory reaction to the sclerotherapy agent in the area surrounding the injected vein. In addition, there are systemic complications that are now becoming increasingly understood. These occur when the sclerosant travels through the veins to the heart, lung and brain. A recent report attributed a stroke to foam treatment, although this involved the injection of an unusually large amount of foam. More recent reports have shown that bubbles from even a small amount of sclerosant foam injected into the veins quickly appear in the heart, lung and brain. The significance of this is not fully understood at this point and large studies show that foam sclerotherapy is safe. Sclerotherapy is fully FDA approved in the USA.