What is Sclerotherapy?
In clinical practice sclerotherapy achieves excellent outcomes for both spider veins and smaller varicose veins. When combined with little (or no) downtime and an impeccable safety reputation it’s the clear choice for many patients. Sclerotherapy is a medical procedure that eliminates spider veins and varicose veins on the face, hands, breasts, legs, chest and other areas. Sclerotherapy is a series of small injections of a specialized solution (a sclerant) directly into the vein. This scarring agent immediately coagulates the small amount of blood trapped inside the veins. The sclerotherapy seals the vein from the inside. The painless sclerosing solution causes scarring in the walls of the vein, causing the veins to shrink, stick together, close off, then be naturally reabsorbed in the body and eventually disappear. Blood is automatically rerouted to healthy nearby veins. In a matter of 2-3 weeks the appearance of the veins diminishes, often fading completely. Sclerotherapy is the preferred method for permanently removing spider veins and smaller varicose veins. In some instances a follow up treatment may be necessary, but this isn’t typical, and results are generally excellent.
Used since the 1930’s, Sclerotherapy, often known as sclero, has become one of the best vein procedures available today. It is most often used to treat veins near the surface of the skin, such as smaller varicose veins or spider veins. Although two to three treatments maybe needed, the results are long-lasting. The actual medication to be used is determined largely on the basis of vein size. Foam is usually the best choice for larger veins to ensure maximal contact of the sclerant to the vein walls.
Why Sclerotherapy is Used?
• To improve cosmetic appearance: Sclerotherapy can assist in clearing clusters of spider veins and small veins to improve the appearance of the legs.
• To improve swelling
• To relieve the feeling of leg heaviness, achiness and fatigue
• To relieve itching and burning
• To relieve muscle cramping
• To improve Restless Leg Syndrome (RLS)
• Generally, those who have spider veins and small varicose veins (less than 3 mm) are good candidates for sclerotherapy, if there are no other limiting factors, for example, diabetes or obesity
• This type of therapy almost always improves the symptoms of Chronic Venous Insufficiency (CVI); however, patients with CVI should have attempted to resolve their symptoms using conservative measures (compression garments, over the counter anti-inflammatory drugs, etc), and should be in good enough health to tolerate a minimally invasive procedure.
Advantages of Sclerotherapy Spider Vein Treatment Include:
- No downtime
- Fewer allergic reactions
- Long-lasting results
- Less likely to stain skin
- Low risk of scarring
Results of sclerotherapy
Most patients see minimal results initially. Peak improvement is usually achieved within six weeks of the initial procedure. At this point you’ll be evaluated to see if you need additional follow-up treatment. When a treated vein is gone, it can’t come back since it’s physically been reabsorbed. It is possible that new veins may appear, especially in individuals prone to vein disease.
Several studies have demonstrated the effectiveness of sclerotherapy for spider veins and smaller varicose veins as a 60-80% success rate for permanently eliminating the problem veins.
Is Sclerotherapy safe?
Sclerotherapy is safe. The medication doesn’t travel through the bloodstream, and once the vein is closed the blood is rerouted to nearby healthy veins. Sclerotherapy improves overall circulation and often alleviates vein-related symptoms such as achiness and swelling. Sclerotherapy can also stop the progression of vein disease by preventing smaller varicose veins from becoming larger.
Sclerotherapy Side Effects
Sclerotherapy is very safe and is tolerated well by most patients. Adverse effects are rare and most often minor. Some patients may experience:
Skin Discoloration: It is not uncommon for patients to notice areas of discoloration after sclerotherapy or laser treatment. It is important you understand it will get worse before it looks better. Using compression stockings will help promote the healing process. Depending on the extent of the work that was done, and the severity of the resulting bruising, you may consider wearing compression garments for two weeks to three months. There are also a number of helpful topical ointments like Melaquin or Scleroquin which you can find online.
Whether your spider veins are treated by laser/light therapy or with sclerotherapy, once the vein is closed off, a small quantity of blood will be trapped inside of the vein. This will initially lead to a darker appearance. Additionally, you may notice a lump or hard area until it is completely reabsorbed. This process usually takes between 6-8 weeks. If you notice that your vein isn’t becoming lighter as time progresses, a follow-up appointment is recommended.
Are You a Good Candidate for Sclerotherapy?
Patients receive an initial consultation with a vein specialist to decide if they are a good candidate for sclerotherapy. Veins that are potentially usable for future heart bypass surgery will generally not be considered for sclerotherapy.
There are several reasons that Sclerotherapy may not be the best treatment option for you.
- Pregnancy: Three months after delivery sclerotherapy may then be a good option.
- Blood clots: Current or past issues with abnormal blood clotting.
- If you are breast feeding.
- Some diseases: For example cancer.
- Allergies: This is assessed for each patient.
If you don’t have any of the above complications, you are likely a good candidate for sclerotherapy!
If you’re not a candidate for Sclerotherapy there are other options available such as laser or Radiofrequency treatments.
Preparing for your Sclerotherapy appointment
A thorough physical exam and a detailed medical history are completed before the sclerotherapy procedure.
Your provider will:
• Assess the veins which are to be treated.
• Screen for pre-existing blood vessel or circulatory disease.
Your provider will take a detailed medical history prior to any treatment.
• Pre-existing medical conditions and any current illnesses, especially a history of blood clots in the legs.
• A review of medications and supplements taken on a regular basis. This includes Nonsteroidal Anti-inflammatory Drugs (NSAIDs) such as aspirin and ibuprofen, which can thin the blood and lead to increased bleeding.
• Allergies, including latex
• A history of previous vein treatments, and if these procedures were successful.
If you do take NSAIDs regularly, or prescription blood thinners, you’ll may be instructed on how to temporarily wean yourself off from these medications to avoid unnecessary bleeding during or after the procedure.
Ultrasound Doppler exam
A “Doppler” is the gold standard imaging study for blood vessels such as veins, and is both comfortable and safe.
PREPARING FOR TREATMENT
Don’t apply lotions, fragrances, or shave for 48 hours prior to your treatment. Wear comfortable, breathable clothing, preferably shorts if possible. It helps to be well hydrated.
What to expect with a Sclerotherapy treatment
This is most often done in an outpatient, in-office setting. It doesn’t require general anesthesia (where the patient is “put under”), and usually takes only about one hour. No driver is required post treatment.
The Sclerotherapy procedure is simple. Depending on what area is being treated, you’ll most likely lie on your back with your legs elevated above heart level. The area will be sterilized with disinfectants. A small cosmetic procedure needle (Botox needle) is used to introduce tiny amounts of the sclerosing solution into the vein.
This medicine works by causing heavy irritation to the inner lining of the vein. This effectively causes the vein to collapse, cutting off blood flow. The blood flow is automatically rerouted to nearby working veins. Sometimes a local anesthetic such as lidocaine is used. The procedure is minimally invasive and this isn’t usually necessary.
Soon the vein gets absorbed back into the body as part of the natural healing process. This technique works wonders on clusters of spider veins, and for larger varicose veins (less than 3 mm) a foam-type medication is used. The foam expands once in the vein for better contact with the vein walls.
Pain during the procedure is minimal. Some short term injection site redness and inflammation can occur. If above normal pain is present, this usually means that the solution has leaked into the surrounding tissue. This doesn’t cause permanent harm and will resolve quickly on its own.
When the needle is removed, your provider will dress the wound with a compression dressing to keep pressure on the area. Multiple veins can usually be treated in one appointment. The number of injections you’ll need varies by individual, and depends on how large the individual veins are, how much of an area they cover, and which solution is used.
Sclerotherapy After Care
After care is a straightforward and simple. Standing and walking immediately after the sclerotherapy treatment is encouraged and is important in the prevention of blood clots. Most patients return to their normal, daily activities the same day. Missing work or school after a sclerotherapy treatment is rare.
For best results, it’s recommended that you wear compression socks for about two weeks after your procedure. This keeps pressure on the treated veins. You’ll also likely be asked to avoid very strenuous activity such as lifting weights for two weeks after the procedure.
It’s also good to limit sun exposure to the treatment area of skin for the first six weeks. Inflammation of the injection sites can cause a harmless darkening of the skin, and excessive sun exposure tends to make this worse. As this pigment can become permanent, it’s advisable to stay out of the sun, especially for dark skinned patients.
Patients should avoid taking certain medications including over the counter drugs (Aspirin, Ibuprofen, anti-inflammatory drugs), dietary supplements, herbs and antibiotics and should avoid wearing lotion or tanners on the treated area.
Because vein disease is progressive and has no cure, we recommend regular follow-up visits after every type of treatment.
Sclerotherapy Side Effects Include:
- Minor bruising
- Temporarily darkened skin
- The temporary appearance of small reddish blood vessels. These almost always subside within several weeks. In almost all cases the final effect is the treated veins look as if they had never been there.
- Bigger veins that are injected may become hard or lumpy and require months to fade and dissolve.
- Spots or brown lines may appear at the vein injections site. Usually, they will fade away within 3 to 6 months, but some marks can last for longer.
- Neovascularization is a development of small blood vessels that may occur at the sclerotherapy treatment site. These small off-shoot veins may show weeks or months after a treatment, but usually disappear within 3 months to a year, often a second but smaller (clean-up) treatment may be needed.
Adverse reactions which may need medical treatment
It’s exceedingly rare, but some patients experience side effects for which they must seek medical attention.
These can include:
• Excessive inflammation. Some inflammation is expected as part of the natural healing process. This will almost always subside on its own, but if it persists over the counter anti-inflammatory medications are almost always sufficient.
• Surface blood clot. Sometimes a clotted bit of blood may become trapped in the skin overlying the veins being treated. In such cases draining them is a simple matter. Very rarely blood clots can become deposited in the large veins of the leg, which is referred to as a Deep Vein Thrombosis (DVT). A lump of clotted blood may form in a treated vein that may require drainage. Once a DVT is formed in the legs, there’s a small chance it will travel to the lungs. This is a medical emergency which can affect the arteries feeding the lungs and requires attention immediately. If the leg becomes painfully swollen and warm to the touch, seek medical help immediately.
• Air bubbles, also uncommon, and less serious than DVTs, are the formation of small air bubbles in the veins surrounding the treated area. Most often these cause no symptoms, yet in extremely rare cases they can travel to vital nearby veins and potentially reduce blood flow. If you feel faint, nauseous, have a severe headache, or are experiencing visual symptoms seek emergency treatment immediately.
• Allergic reaction to the medication can occur in rare circumstances. In such instances over the counter anti-inflammatory medications or prescription medications such as steroids are sometimes used.
Are there alternatives to Sclerotherapy?
Several alternative treatments to sclerotherapy are available. The right one for you depends on your individual situation. Treatments other than Sclerotherapy are other variations of sclerotherapy, phlebectomies (removing the veins surgically), or Radio Frequency Ablation (RFA). It’s essential to sit down with a doctor to discuss your options to determine the best choice for your individual situation.
How long-lasting are the results of sclerotherapy, and is maintenance treatment required?
The longevity of sclerotherapy results can vary, and maintenance treatments may be necessary in some cases. Here are considerations:
- Varies by Individual: The duration of results depends on factors such as the type and size of treated veins, individual response to treatment, and lifestyle factors.
- Permanent for Some Veins: Sclerotherapy can permanently eliminate smaller veins, especially spider veins. Larger veins may require additional sessions or may not disappear completely.
- Maintenance for Recurrence: New veins may develop over time or existing ones may recur. In such cases, maintenance sessions may be recommended to address these issues.
- Follow-Up Assessments: Periodic follow-up assessments with your healthcare provider can help determine the need for maintenance treatments and assess the overall success of the procedure.
What factors determine the success of sclerotherapy, and are there factors that may affect its efficacy?
The success of sclerotherapy is influenced by various factors, and certain elements can impact its efficacy. Here are key considerations:
Factors Affecting Success:
- Vein Size and Type: Sclerotherapy is generally more effective for smaller veins, such as spider veins, compared to larger varicose veins.
- Skill and Experience of the Provider: The expertise of the healthcare professional administering the treatment plays a crucial role in its success.
- Patient’s Overall Health: General health, including circulatory and vascular health, can affect the response to sclerotherapy.
Factors Affecting Efficacy:
- Vein Characteristics: Some veins may be resistant to sclerotherapy, and the effectiveness can vary based on the specific characteristics of the veins being treated.
- Underlying Vascular Conditions: Certain vascular conditions, such as chronic venous insufficiency, may affect the success of sclerotherapy.
- Hormonal Factors: Hormonal changes, such as those occurring during pregnancy or with the use of hormonal medications, can influence the development of new veins.
Sclerotherapy is more commonly known as “sclero” by both patients and providers. The goal of the treatment is to close down clusters of spider veins and small varicose veins (less than 3mm wide). Once they have collapsed, they are absorbed back into the body, improving the leg’s appearance and usually improving symptoms of vein disease.
A specialized medication known as a sclerant or sclerosant is injected directly into the problematic vein. This irreparably damages the inner lining of the veins, known as the endothelium. This completely closes the vein, “scarring it down.” The blood is automatically rerouted to nearby networks of healthy veins. Soon the vein is reabsorbed into the body as if it were never there.
Sclerotherapy treats spider and varicose veins and improves overall health with minimal downtime and long lasting to permanent results. Most patients do not scar and there are few allergic reactions.
For those patients whose issues are mainly cosmetic, sclerotherapy directly improves the appearance of their legs. For those with generalized symptoms such as swelling, achiness, and fatigue, sclerotherapy has a proven track record of resolving these complaints. In all cases, overall circulation is improved when sclerotherapy is used correctly, as it shuts down non-working veins.
A significant advantage of sclerotherapy is that it causes virtually no downtime. Patients can resume all normal activities except high-intensity exercise right away. In many cases patients schedule a sclerotherapy session over their lunch break and return to work directly afterwards
Yes. Sclerotherapy by its nature is non-invasive. Although all medical procedures which break the skin carry some risk, sclero is regarded as both safe and effective; however, since this is usually done for cosmetic reasons, an individual should perform a risk versus benefit analysis, especially for those patients who are prone to infection.
No, according to most patients sclerotherapy is not painful. There will be several uncomfortable needle sticks, which feel like pin pricks, as the sclerosant is injected. The solution itself can cause irritation which might be a slight burning sensation. In general the discomfort is minor.
Sclero is effective on nearly all veins, if they’re small enough and close enough to the surface. Very large varicose veins usually require surgical removal (phlebectomy).
Sclerotherapy is performed with injections from a very small needle into the vein. Two sclerotherapy drugs currently have FDA approval for treating spider veins and smaller varicose veins. These sclerants, or sclerosing agents, are sodium tetradecyl sulfate (a chemical detergent) and polidocanol. These medications are injected directly into the vein being treated using as small a needle as possible.
For the small spider veins, hypertonic saline is often used. It contains no medication, but can cause enough irritation to the vessel walls to shut the vein down. The number of veins treated varies, depending on the patient’s medical condition, and the location of the tiny veins.
Sclero therapy is performed in a doctor’s office by a physician, physician’s assistant or registered nurse.
Usually not. Sclero is an in-office treatment which is minimally invasive. Other than strenuous activity or exercise, patients normally resume their normal activities immediately.
Post treatment, patients will be asked to wear prescription grade compression garments for about two weeks after the procedure. At this time the patient has a follow up visit to evaluate the success of the sclerotherapy. If the veins treated were larger than small spider veins, a Doppler ultrasound is usually performed to make certain that no blood clots are present.
Sclerotherapy is regarded as extremely safe and effective, and adverse reactions are exceedingly rare. Mild side effects include itching and redness which can last up to 2 days. Temporary pain and swelling may occur, which can be managed with Over the Counter (OTC) pain medications. Bruising may also occur and can last up to a few weeks.
Occasionally dark splotches appear over the area which was treated, known generally as hyperpigmentation. This is rare, and poses no threat of any kind. Most cases will resolve themselves completely within six months. This happens when the area is treated and red blood cells disintegrate and leak into surrounding tissue.
Another concern is the formation of more spider veins. This is unavoidable in some patients, but these new clusters of vessels will usually disappear on their own as the body’s venous drainage compensates for new flow patterns.
More serious but rare side effects include brown spots, large veins becoming hard or lumpy for a few months and Neovascularization.
Since Sclerotherapy does use needles, which break the skin, infection is possible but rare, and can be treated with antibiotics. In even rarer cases, blood clots can form in the legs which can travel elsewhere in the body, which is potentially life threatening but is easily screened for using ultrasound.
This ultimately depends entirely on the patient’s insurance plan. As a general rule, if the patient is being treated for cosmetic reasons coverage will usually be denied. A thorough medical exam is essential before treatment begins, since it can establish that the treatment is medically necessary.
For small clusters of spider veins, both lasers and sclerotherapy injections can be effective.
Which one is right for you depends on your unique situation.
As a very general rule, lasers work very well at permanently removing unsightly clusters of spider veins, if the area they cover isn’t extensive. These smaller areas are usually found on backs of the calves or around the knees.
Larger, bulging varicose veins can’t be treated properly with lasers, and sclerotherapy is often used in cases like this.
If you’ve only got several small areas of spider veins or are afraid of needles, then laser therapy might be your best bet. It works particularly well on spider veins on the face. Also, in cases where the patchwork of veins is very extensive, leading to a dark purple matted appearance, a.k.a. telangiectatic matting, then laser treatment is the best option because the individual veins are far too small to directly inject.
Laser therapy does, however, tend to be the more expensive option. For many patients sclerotherapy makes more sense, it’s less expensive, faster, and of equal effectiveness.
When done correctly, both methods achieve the same goal, namely the permanent reduction of the spider or varicose veins in question.
Sclerotherapy has a better track record on patients with darker skin tones.
Lasers depend on plenty of contrast between the color of the vein and the pigment in the skin, and naturally darker skin tones reduce this contrast.
Foam Sclerotherapy has an outstanding track record in the treatment of unsightly, reddish, purplish clusters of spider veins. This involved directly injecting a foam-type medication, over a 20 to 40 minute treatment, using usually very small cosmetic needles, into the veins in question, which causes the spider veins to collapse. No anesthetic is usually necessary. Blood is immediately shunted to nearby healthy veins, and the treated vein is reabsorbed and disappears.
The foam medication is known as a sclerant or scarring agent. A sclerosing solution such as Asclera (polidocanol) or sodium tetradecyl sulfate (STS) is whipped into a foam with about the same density as shaving cream. This solution is visible on ultrasound, and it is for this reason that many of these procedures are done using ultrasound guidance. Once injected, the foam like consistency of the solution ensures maximum contact with the vein walls, causing intense irritation which causes the vein to collapse in on itself. The vein scleroses or “scars up,” and will eventually shrink as it is reabsorbed back into the body.
The number of sessions needed is determined solely by the size and number of the veins being treated.
It’s important to remember that the spider veins or small varicose veins in question aren’t working properly to begin with, and when treated blood immediately begins to re-route to nearby healthy veins. As such, this procedure improves overall circulation.
This procedure is considered cosmetic by nearly all health insurance carriers, and often won’t be covered. If the vein problem is severe or long standing, it may be deemed medically necessary, at which point insurance may cover the cost.
Sclerotherapy is the best treatment of spider veins by far!
Sclerotherapy is a non-invasive treatment for spider veins and smaller varicose veins.
Several highly effective, minimally invasive techniques are in use today which get rid of large, ropey varicose veins permanently. Yet, while minor, these are still surgical procedures, carry some level of risk, and cause some amount of downtime. These treatments are often “too much” for spider veins and smaller varicose veins, leaving many patients in an awkward position. They’d like to take action but don’t want to commit to surgery, no matter how minimally invasive.
Fortunately, sclerotherapy is a noninvasive, injection-based approach which fills in this gap perfectly. It can easily handle these small surface veins with virtually no downtime or risk.
During a sclerotherapy session small amounts of a powerful irritant medication are injected directly into the vein. This immediately causes large amounts of inflammation in the walls of the vein which then essentially swells shut. This permanently seals the vein, which is then reabsorbed by the body in the following weeks. In about 2 months it’s as if the unwanted vein was never there.
If you’re interested and want to learn more the first step is scheduling a free consultation. Call the Advanced Vein Center today at (724) 987-3220.