Sclerotherapy

Sclerotherapy is a medical procedure that treats varicose veins and spider veins, usually on your legs. Your healthcare provider uses a needle to inject a special solution into your vein. The chemical solution irritates your blood vessel lining. This makes it expand, stick together and form a scar. It closes off your vein, making it look and feel better.

What happens during sclerotherapy?

Your healthcare provider will perform sclerotherapy in their office. It takes about 30 to 45 minutes.

Before starting, your provider may try a test injection to make sure you don’t have a reaction to it.

They’ll follow these steps:

• Pathway mapping: They may use sound waves (ultrasound) to help them find the right veins to treat. They’ll start with the largest veins.
• Cleaning: They’ll use alcohol or another disinfectant to make sure the treatment area is free of germs.
• Skin stretching: They’ll stretch your skin out around the injection site. An assistant may use their hands to help with this.
• Injecting: Using a very fine needle, a provider will inject a liquid or foam solution. This goes directly into your blood vessel. They’ll select the chemical and amount of it based on the size of the vein they’re treating.

You’ll feel the needle pinch your skin, and possibly a mild burning feeling. You may feel mild discomfort when the injection goes into your veins. In larger veins, you may feel cramping for a minute or two during the injection.

After your sclerotherapy treatment, your provider may ask you to keep lying down for 15 minutes or so. They want to make sure you don’t have a bad reaction to the injected substance.

The number of veins your provider treats in one session depends on the size and location of your veins. They’ll also consider your overall medical condition.

This treatment isn’t for everyone. Before the procedure, you’ll meet with a vascular specialist who’ll help you decide if it’s right for you.

It’s not an option for you if you:

• Have an active blood clot in a vein
• Are pregnant
• Are breastfeeding
• Can’t get out of bed

If you’ve had a blood clot in the past, you may be able to have sclerotherapy. It depends on what caused the clot and how serious it was.

In most cases, your provider won’t do this treatment on a vein you might need for future procedures. This includes the saphenous vein for heart bypass surgery.

How successful is this treatment?

Sclerotherapy works well on smaller varicose veins. A session may get rid of an estimated 50% to 80% of injected veins. In some cases, the treatment doesn’t work. If this happens, your healthcare provider can try different solutions or another method, like laser therapy.

It’s a good idea to talk with your provider about how well they think sclerotherapy treatment will work for you. Some people who expect the treatment will work wonders aren’t happy with their results. Knowing what to expect can help you avoid feeling let down. You should also know that results aren’t instant. You won’t walk out of your provider’s office looking like a leg model.

What are the potential benefits and risks of this treatment?

Benefits of vein sclerotherapy include:

• No anesthesia: With enough compression from the bandage on the vein, there’s little pain. Compression may also help with bruising and swelling.
• Fairly quick results for small veins: Spider veins usually respond to treatment in three to six weeks, but it may take three to four months for larger veins.
• Lasting treatment when successful: Although you may need more than one injection session, the problem doesn’t happen again when treatment works. But you may need treatment for new varicose veins that form.

Sclerotherapy takes longer than surgery for varicose veins or spider veins. And it has risks of infection, blood clots and inflammation. It can also have side effects.

Side effects of sclerotherapy may include the following:

• Lumpiness or hardness: Larger injected veins may get lumpy or hard for several months.
• Redness: This can happen where the needle went in, but it should go away within a few days.
• Brown lines or spots: These appear on your skin at the site of the injection, but usually go away within three to six months.
• Bruising: This can show up where the injection was and can last several days or weeks.
• Appearance of tiny blood vessels: They may appear in the treated area days or weeks after your sclerotherapy. They should fade within a few months and probably won’t need more treatment.
• Allergic reactions to the injected chemical: These may happen at the time of the injection and are rarely serious. Symptoms include itching and swelling.

How long will it take for me to feel better?

It doesn’t take long to recover from vein sclerotherapy. After treatment, you can drive home and get back to your normal activities. Walking is good for your recovery. Your healthcare provider may suggest it.

You should wear support stockings or compression wraps for three to seven days to compress the treated vessels. Regular support stockings from a retail store may not work.

For 48 hours after treatment, follow these sclerotherapy aftercare guidelines:

• Avoid aspirin, ibuprofen and other anti-inflammatory medicines. You may take acetaminophen if you need it for pain relief.
• Don’t take hot baths or sit in a whirlpool or sauna. You may take showers, but the water should be cooler than usual.
• Wash the injection sites with mild soap and lukewarm water.
• Don’t apply hot compresses or any form of heat to the treated areas.
• Avoid direct exposure to sunlight (including sun tanning and tanning beds).

Is there anything I can do to make this treatment easier on me?

Before your sclerotherapy treatment, you should avoid certain drugs. Ask your healthcare provider for guidance on taking or stopping these medicines:

• Antibiotics like tetracycline or minocycline: These may make your skin stain if you take them seven to 10 days before or after treatment.
• Aspirin, ibuprofen or other medications for inflammation: These may get in the way of the action of the injected substance or make you bleed more.
• Prednisone: This keeps the injected substance from working as well as it should.

Other guidelines before your procedure include:

• Don’t put any lotion on your legs before or after sclerotherapy.
• Bring a pair of shorts to wear for your procedure.

If you have compression stockings from past treatments, bring them with you. Your provider can make sure they give you enough support.

When should I call my healthcare provider?

If you have any of these rare side effects, contact your healthcare provider right away:

• Inflammation within 5 inches of your groin
• Sudden swelling in your leg
• Small ulcers at an injection site
• Red streaking, especially in your groin area

Call your provider if you have any concerns or questions after your procedure. You’ll most likely see them for a follow-up visit a month or two after sclerotherapy treatment. You may have a physical exam, blood tests or imaging. If you’re having multiple treatments, you may have your next session two or three months after your first one.

Is laser treatment better than sclerotherapy?

Laser treatment, or endovenous thermal ablation, is generally safe. But it can have some side effects, just like you do with sclerotherapy. It’s difficult to do ablation on a varicose vein that has a lot of twists and turns. Your healthcare provider will need to consider what your veins look like when deciding on the best treatment for you.