Sclerotherapy

What is sclerotherapy?

Sclerotherapy is a treatment for patients with varicose veins and “spider veins.” It involves injecting a solution directly into the vein(s). The solution irritates the vein lining, causing it to swell and stick together. Over time, the vein turns into scar tissue that fades from view. Sclerotherapy is very effective and has been used since the 1930s.

What happens during the procedure?

Sclerotherapy is done in your healthcare provider’s office. Depending on the size of the veins, where they are and your overall health, you may be able to have several injections during one visit. Your healthcare provider will clean the area(s), and use a very fine needle to inject the solution into the vein(s). Please follow the instructions on this page, along with any other information you may get from your healthcare provider, and let us know if you have any questions or concerns.

How well does sclerotherapy work?

Sclerotherapy works well for most patients. The success rate is as high as 50% to 80% of veins injected during each treatment session. Less than 10% of patients who have sclerotherapy do not respond to the injections at all. If your treatment is unsuccessful, your healthcare provider may recommend a different type of sclerotherapy solution or another type of treatment, such as laser therapy.

In general, it takes 3 to 6 weeks for spider veins and 3 to 4 months for larger veins to fully respond to treatment. Larger veins can get lumpy or hard as they respond to treatment. Veins that respond to the treatment usually do not return. But, over time, new veins can appear.

Can I have sclerotherapy?

Before the procedure, you will meet with a vascular specialist to see if you are a good candidate for sclerotherapy.

You cannot have sclerotherapy if you are pregnant (You can be evaluated for the procedure 3 months after delivery), breast feeding or can’t get out of bed. You can have sclerotherapy if you take birth control pills. If you have ever had a blood clot, your healthcare provider will consider your personal history, including the cause and area of the clot, when evaluating you for sclerotherapy.

Sclerotherapy is not usually used on veins that may potentially be used for bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery), unless it is already considered unusable.

Will my insurance cover sclerotherapy?

Check with your insurance company to see if the cost of sclerotherapy is covered. The cost is not covered if you have sclerotherapy for cosmetic reasons. But, some companies cover the cost if the treatment is related to some medical conditions.

Your insurance company may request a letter from your healthcare provider to provide details about your treatment. If you have questions about the cost of the consultation, treatment or post- procedure stockings, please contact a Cleveland Clinic Financial Advocate at 216.445.6249 (toll-free 866.621.6385) or online: my.clevelandclinic.org/patients/billing-finance.

How do I prepare for the procedure?

Medicine - Do not stop taking any type of medicine without first talking to your healthcare provider.

• Tetracycline and minocin can cause your skin to stain if you take them within 7 to 10 days of sclerotherapy. If you need to take one of these antibiotics, ask your healthcare provider if you can take a different type of medicine or safely stop taking these before your treatment. Please tell your healthcare provider if you need to take a preventive antibiotic before dental or medical procedures.
• Do not take aspirin, ibuprofen (Motrin, Advil) or other anti-inflammatory medicine for 48 hours before and after sclerotherapy. They can keep the sclerotherapy solution from working properly and cause bleeding. It is OK to take acetaminophen (Tylenol).
• Prednisone keeps the sclerotherapy solution from working If you take prednisone, talk to the healthcare provider who prescribed it if you can safely stop taking the medicine 48 hours before your sclerotherapy procedure.

Other Information

• DO NOT put lotion on your legs before or after your procedure.
• Bring a pair of shorts to wear during your procedure.
• If you have compression stockings, please bring them with you.

Does sclerotherapy hurt?

You may have mild discomfort when the veins are injected. You may feel cramping for 1 to 2 minutes when larger veins are injected.

How long does it take?

The sclerotherapy procedure takes about 30 to 45 minutes.

What side effects can sclerotherapy cause?

Possible side effects of sclerotherapy include:

• Raised, red areas at the injection sites. These should disappear within a few days.
• Brown lines or spots on your skin at the injection sites. These may be caused by iron that escapes from the blood in the injected veins. The lines/spots usually disappear in 3 to 6 months, but there is a small chance (about 5%) that they can be permanent.
• Bruising around the injection sites. This can last several days or weeks.
• Temporary tiny blood vessels in the treated areas. This is called revascularization (also called flares, mats or blushing). They can appear days or weeks after the procedure, but usually fade within a few months.
• An allergic reaction (itching, swelling) to the sclerotherapy solution. This is not usually serious.

Rare side effects include:

• Swelling within 5 inches of your groin.
• Sudden swelling in your leg.
• Small ulcers (open wounds) at the injection site(s).
• Red streaks, especially near your groin.

If you have any of these symptoms, call your healthcare provider!

What happens after my treatment?

• You will be able to drive yourself home.
• You will be able to return to your usual activities.
• It is important to walk. You will need to wear support stockings or compression wraps to keep the treated veins squeezed into place. Your healthcare provider will prescribe these. Make sure you get the right size and strength. Stockings are available at Cleveland Clinic and local pharmacies.

For 48 hours after your procedure

• Use a mild soap and lukewarm water to wash the treatment area(s) for 48 hours after your procedure.
• If you have pain, you may take acetaminophen (Tylenol).

For 48 hours after your procedure:

• DO NOT take aspirin, ibuprofen or other anti-inflammatory medicine.
• DO NOT take a hot bath or sit in a whirlpool or sauna. You may take showers, but keep the water cooler than usual.
• DO NOT use hot compresses or any type of heat on the injection site(s).
• Avoid direct sunlight (including tanning beds).

Call your healthcare provider if you have any questions or concerns.