Sclerotherapy

What is 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 varicose vein or spider vein. This chemical solution irritates your blood vessel lining, making it expand, stick together and form a scar. This closes off your vein, making it look and feel better.

Who needs to have sclerotherapy treatment?

Sclerotherapy may be appropriate for people with varicose veins or spider veins, but it’s not for everyone.

Before the procedure, you’ll meet with a vascular specialist who’ll decide if you qualify for sclerotherapy.

You’re not eligible for sclerotherapy if you:

• Have an active deep vein thrombosis or superficial vein thrombosis (blood clot).
• Are pregnant. You’ll have to wait at least three months after delivery before you can have sclerotherapy.
• Breastfeeding (chestfeeding).
• Unable to get out of bed.

You can still get sclerotherapy if you take birth control pills.

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

In most cases, your provider won’t do sclerotherapy on a vein you might need for future surgical bypass procedures, such as the saphenous vein for coronary artery bypass graft surgery (unless that vein is already unusable).

It’s a good idea to talk with your provider about how successful they think sclerotherapy treatment will be for you. Some people with high expectations are disappointed with their results. Knowing what to expect can help you avoid feeling disappointed. You should also know that results aren’t immediate. You won’t walk out of your provider’s office looking like a leg model.

What happens before sclerotherapy?

Before your sclerotherapy treatment, you should avoid certain medications. Follow these guidelines:

• Antibiotics such as tetracycline or minocycline (Minocin® or Dynacin®) may make your skin stain if you take them seven to 10 days before or after sclerotherapy. Ask your healthcare provider about other antibiotic medications you may take, or ask for safe guidelines for stopping these medications. Tell your provider if you need to take an antibiotic before invasive procedures.
• Don’t take aspirin, ibuprofen (Advil® and Nuprin®) or other anti-inflammatory medications for 48 hours before and after sclerotherapy. These medicines may get in the way of the action of the sclerosing agent or make you bleed more. It’s ok to take acetaminophen (Tylenol® or Panadol®). Ask your provider for specific instructions before you stop taking any medication.
• Prednisone (Rayos® or Sterapred®) makes the sclerosing agent less effective. Ask the provider who prescribed your prednisone if you can safely stop taking it for 48 hours before your sclerotherapy treatment.

Other guidelines before your procedure:

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

If you have compression hosiery (support stockings) from previous treatments, bring them with you so your provider can make sure they’ll give you enough support after your procedure.

What happens during sclerotherapy?

Your healthcare provider will perform sclerotherapy in their office. They may use an ultrasound to help them find the right vein to treat.

Sclerotherapy treatment takes about 30 to 45 minutes. You’ll lie on your back or your stomach, depending on the location of the vein they’re treating.

Your provider can choose from several chemicals available for use in sclerotherapy. They’ll select the appropriate chemical and concentration of it based on the size of the vein they’re treating.

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

They’ll follow these steps:

1. Clean the treatment area.
2. Stretch your skin out around the injection site. An assistant may use their hands to help with this while your provider gets ready to put the needle into your skin.
3. Inject a liquid or foam solution directly into your blood vessel, using very fine needles.

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.

The number of veins your provider treats in one session depends on the size and location of your veins, as well as your overall medical condition.

What happens after sclerotherapy treatment?

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

You’ll be able to drive yourself home. You may go back to your regular activities, especially walking.

You should wear support hosiery or compression wraps for three to seven days to compress the treated vessels. Support stockings purchased from a department store may not work if your healthcare provider prescribes a heavy compression stocking.

For 48 hours after your procedure, follow these guidelines:

• Avoid aspirin, ibuprofen and other anti-inflammatory medications. 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).

Call your provider if you have any concerns or questions after your procedure.

What are the advantages of sclerotherapy?

Advantages of sclerotherapy include:

• No anesthesia. With enough compression from the bandage on the vein, there is little pain. Compression also may help with bruising and swelling.
• Good results for most people. Sclerotherapy works especially well on smaller varicose veins. A session may get rid of an estimated 50% to 80% of injected veins. In about 10% of cases, sclerotherapy doesn’t work. If this happens, your healthcare provider can try different solutions or a different method, such as laser therapy.
• 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.
• With successful treatment, varicose veins or spider veins won’t reappear. However, you may need treatment for new varicose veins that form.

What are the risks or complications of sclerotherapy?

Sclerotherapy takes longer than surgery for varicose veins or spider veins. It can also have side effects.

Side effects of sclerotherapy may include the following:

• Larger injected veins may get lumpy or hard for several months.
• The redness where the needle went in should go away within a few days.
• Brown lines or spots on your skin at the site of the injection usually go away within three to six months. However, about 5% of the time, they can be permanent.
• Bruising where the injection happened can last several days or weeks.
• Tiny blood vessels may develop in the treated area. They may appear days or weeks after your sclerotherapy but should fade within a few months. Usually, they don’t need further treatment.
• Allergic reactions to the injected chemical may happen at the time of the injection and are rarely serious. Symptoms include itching and swelling.

Other side effects rarely develop after sclerotherapy.If you have any of these rare side effects, contact your healthcare provider immediately:

• Inflammation (swelling) within five inches of your groin.
• Sudden swelling in your leg.
• Formation of small ulcers at an injection site.
• Red streaking, especially in your groin area.

What is the recovery time?

It doesn’t take long to recover from sclerotherapy. After treatment, you can drive home and get back to your normal activities. Walking is good for your recovery, so don’t be surprised if your healthcare provider recommends it.

When should I see my healthcare provider?

You’ll most likely see your healthcare provider 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.

Will my insurance cover sclerotherapy?

Insurance companies don’t provide coverage for sclerotherapy when it’s performed for cosmetic reasons. Some insurance companies cover sclerotherapy for specific medical conditions. Your insurance company may request a letter from your healthcare provider about the nature of your treatment. It’s a good idea to contact your insurance provider to confirm that they’ll cover sclerotherapy before you consider it.

Is laser treatment better than sclerotherapy?

Laser treatment, or endovenous thermal ablation, is another good alternative to ligation and stripping of varicose veins. It’s generally safe but can have some side effects like you do with sclerotherapy. However, 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.

A note from Cleveland Clinic

Varicose veins can be hard to live with, but sclerotherapy works for many people. Having a conversation with your healthcare provider will help you understand your treatment options so you can decide if sclerotherapy is right for you. It’s good to know what to expect from the procedure. For the best results, be sure to follow all of your provider’s instructions before and after sclerotherapy.