Sclerotherapy for varicose veins

Treatment Overview

Sclerotherapy uses an injection of a special chemical (sclerosant) into a varicose vein to damage and scar the inside lining of the vein. This causes the vein to close.

During this procedure, the affected leg is elevated to drain blood, and the sclerosant is injected into the varicose vein. The procedure is done in a doctor's office or clinic and takes 5 to 30 minutes, depending on how many varicose veins are treated and how big they are.

After the injection of sclerosant is given, pressure is applied over the veins to prevent blood return when you stand up. You may need to wear compression stockings or elastic bandages for several days or weeks to maintain the pressure.

The sclerotherapy injection may be painful, and the chemical (sclerosant) that is injected can cause a feeling of burning or cramping for a few minutes in the area where the shot was given. You may need repeated sessions and many injections per session depending on the extent of the varicose veins and type of sclerosant used.

A newer technique allows your doctor to inject sclerosant with a catheter. The catheter and sclerosant are guided to the affected vein with the help of duplex ultrasound. This process allows sclerotherapy treatment to be used on larger varicose veins that previously could only be treated surgically with ligation and stripping, in which larger varicose veins are tied off and removed. Sclerotherapy will likely be more safe and effective using the duplex ultrasound–guided catheter injection because it allows easy and precise access to veins.¹

In addition, early studies show that when used with duplex ultrasound guidance, foam sclerosant has some advantages over liquid sclerosant. Foam sclerosant may be safer, more effective, and lower in cost than conventional liquid sclerosant.^{2, 3} Foam for treating large veins is not yet widely available in the United States.

What To Expect After Treatment

Sclerotherapy generally does not require any recovery period. You will usually be able to walk immediately after the treatment but should take it easy for a day or two. While bed rest is not recommended, you may need to avoid strenuous exercise for a few days after sclerotherapy.

You will probably have to wear compression stockings after having sclerotherapy. Doctors disagree on how long a person needs to wear the stockings after having treatment. Some think that several weeks is necessary, but others think a few days is enough.

Why It Is Done

Sclerotherapy is used to treat:

• Spider veins and small veins that are not causing more serious problems.
• Smaller varicose veins that come back after vein-stripping surgery.
• Larger varicose veins, when newer techniques are used.

Sclerotherapy may be done alone or as a follow-up to surgery.

Sclerotherapy should not be done if you:

• Are pregnant or nursing. It is not known whether the chemical (sclerosant) causes birth defects or problems with breast milk.
• Have a history of allergy to sclerosant or similar substances.
• Have blood clots or inflammation in the deep leg veins (deep vein thrombosis).

How Well It Works

Sclerotherapy costs less than surgery, requires no hospital stay, and allows a quicker return to work and normal activities.

Sclerotherapy reduces symptoms and improves appearance of the skin in 85% of people who have smaller varicose veins.⁴

Outcomes are not yet known for newer sclerotherapy techniques but appear promising.

Risks

The risks of sclerotherapy include:

• Skin color changes along the treated vein. This is the most common side effect of sclerotherapy. The discoloration may take 6 to 12 months to disappear. In some people, it may be permanent.
• Recurring varicose veins.
• Itching, bruising, pain, and blistering where the veins were treated.
• Scarring resulting from ulcers or death of the tissue around the treated vein (skin or fat necrosis) if sclerosant is injected outside a vein or sclerosant escapes through the wall of a weakened vein.
• A mild or severe (anaphylactic) reaction to the sclerosant. (Severe reaction is very rare but can be life-threatening.)
• Blood clots or damage in the deep vein system.

What To Think About

A newer technique involves the injection of a sclerosant in a foamlike form rather than a liquid form. Foam makes better contact with the inside of the vein walls and stays in the vein longer and thus may provide better results.

• Some cities may have large walk-in sclerotherapy clinics. Be sure that the person who does the injections is a doctor who has been trained to do it.
• Using compression stockings after sclerotherapy improves results. Wearing them for 3 weeks results in the greatest improvement; 1 week also shows good improvement. Wearing them for at least 3 days is better than not wearing them at all.⁵

If it is done for cosmetic reasons, sclerotherapy is usually not covered by insurance.

If you are considering sclerotherapy, you might want to consider some questions for consumers. These questions might include: How much experience does the doctor have with the particular treatment? How much do the exam and treatment cost, and how many treatments does the doctor think you will need?

Laser therapy or freezing (cryotherapy) may be used instead of sclerotherapy to treat small veins and spider veins in some cases.

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