Sclerotherapy is an injection of a saline solution (sclerosant) directly into a varicose vein. It is intended to create internal scarring and cause the vein to close. This is usually a stand-alone treatment for spider veins and small varicose veins. It can also be used as adjunct therapy following traditional varicose vein surgery or stripping and ligation.
The procedure
Normally done in a physician's office, this procedure takes less than 30 minutes to complete, depending upon the number of veins being treated and their size.
The affected leg is elevated to drain the blood before the sclerosant is injected. The injections can be uncomfortable despite the very fine needle used, in most cases. There is usually a burning or cramping sensation for several minutes during and after each injection.
There is a newer technique, available by some physicians, using a fine catheter to inject the sclerosant. The catheter is placed in the vein using ultrasound guidance and is considered to be minimally invasive. This technique allows larger veins to be treated in an office setting.
Pressure is applied to the treated area for several days to weeks after the injections. Universally, physicians do not agree on the length of time that compression is necessary; some order it for several days while others firmly recommend several weeks. Compression stockings or ace bandage wraps are are worn by the patient to prevent clotting.
The sclerosant
The medication injected is a saline solution. Typically, the sclerosant is a thin, water-like solution that is easily injected through a very fine gauge needle.
A newer sclerotherapy technique uses a sclerosant in the form of foam. The theory behind the foam is that it adheres to the inside surface of the vein better and for a longer period of time, so it could be more effective in some cases.
Side effects and risks
There are several potential side effects to sclerotherapy:
• Skin discoloration along the treated vein; this often abates within a year but can be permanent
• Varicose vein does not respond to the therapy
• Itching, burning and pain at treated site; itching usually lasts for a couple of days
• Scarring
• Tissue necrosis
• Systemic reaction to the sclerosant
The specially trained physician doing the procedure will review potential risks before the procedure based on each individual case.
Recovery
Repeat sessions, each requiring numerous injections, are needed to treat most patients. The treatment plan is based upon the number and size of the veins being treated.
No specific recovery time is required although avoiding strenuous activities for several days is advised. Patients can walk immediately after sclerotherapy. Bed rest is not routinely suggested in order to prevent blood clotting.
The outcome
Eighty percent of patients undergoing sclerotherapy for varicose veins experience success. The results of sclerotherapy are not fully seen immediately after the injections. Scarring needs to develop along the vein, at which time the treated veins will fade and virtually disappear.
