What is sclerotherapy?
Sclerotherapy is a medical procedure used to treat varicose veins and "spider veins." During sclerotherapy, the physician injects a solution directly into the affected vein. The solution irritates the lining of the vessel, causing it to swell and stick together. Over time, the vessel turns into scar tissue that fades from view. Sclerotherapy is a well-proven procedure and has been used since the 1930s.
How successful is sclerotherapy in treating varicose and spider veins?
Sclerotherapy works well for most patients. It is estimated that between 50 and 80% of injected veins may be eliminated with each session. A few people (less than 10%) who have sclerotherapy do not respond to the injections at all. In these instances, different solutions or a different method, such as laser therapy, may be tried.
In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months. If the veins respond to the treatment, usually they will not reappear. However, new veins may appear over time. If needed, you may return for injections.
How will I know if I am a candidate for sclerotherapy?
Before the procedure, you will meet with a vascular specialist who will evaluate your eligibility for sclerotherapy.
You are not eligible for sclerotherapy if you are pregnant, breastfeeding, or are bedridden. You must wait at least 3 months after delivery before you can be considered for this procedure.
You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility for sclerotherapy will depend on what caused the clot, and how serious it was.
Veins that might be used for future surgical bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery) will generally not be considered for injection, unless they are already deemed unusable.
How is sclerotherapy done?
Sclerotherapy is performed in a doctor's office. The treatment area is cleansed. The solution is injected directly into the blood vessel, using very fine needles. The number of veins injected in one session depends on the size and location of the veins, and the patient's overall medical condition.
What to do before the procedure
Medications: Before the sclerotherapy procedure, certain medications should be avoided. Please follow these guidelines:
- Tetracycline or Minocin, both antibiotics, may possibly cause a staining of the skin if taken 7 to 10 days before or after sclerotherapy. Ask your doctor about other antibiotic medications you may take, or ask for safe guidelines for discontinuing these medications. If you are required to take an antibiotic before any invasive procedure, such as dental procedures, colonoscopy, or surgery, please inform your physician.
- Do not take aspirin, ibuprofen (i.e. Advil® and Nuprin®) or other anti-inflammatory medications for 48 hours before and after sclerotherapy, because these medications may interfere with the action of the sclerosing agent or increase bleeding. Tylenol® is permitted. Ask your doctor for specific guidelines before discontinuing any medication.
- Prednisone makes the sclerosing agent less effective. Ask the doctor who prescribed your prednisone if it can be safely discontinued for 48 hours before the sclerotherapy procedure.
Other guidelines before the procedure
- No lotion should be applied to the legs before or after sclerotherapy.
- We recommend that you bring a pair of shorts to wear during the procedure.
- If you have compression hosiery (support stockings) from previous treatments, please bring them with you so we can make sure they will provide adequate support after the procedure.
How long will the sclerotherapy treatment last?
The sclerotherapy procedure takes about 30 to 45 minutes.
What happens after sclerotherapy treatment?
After the treatment, you will be able to drive yourself home. You may resume your regular activities and are encouraged to walk.
You will be instructed to wear support hosiery or compression wraps to "compress" the treated vessels. Support stockings purchased from a department store may not be sufficient if a heavy compression stocking is prescribed.
For 48 hours after the procedure, please follow these guidelines:
- Avoid aspirin, ibuprofen, and other anti-inflammatory medications. Tylenol® may be used if needed for pain relief.
- Do not 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 a mild soap and lukewarm water.
- Do not apply hot compresses or any form of heat to the injected areas.
- Avoid direct exposure to sunlight (including sun tanning and tanning beds).
Call your physician if you have any concerns or questions after the procedure.
Risks / Benefits
What are the side effects of sclerotherapy?
Side effects of sclerotherapy may include the following:
- Larger injected veins may become lumpy or hard for several months before getting better.
- Raised, red areas may appear at the injection sites and should disappear within a few days.
- Brown lines or spots on the skin may be seen at the site of the injection, possibly caused by a form of iron that escapes from the blood in the injected veins. In most cases, they disappear within 3 to 6 months, but about 5% of the time they can be permanent.
- Bruising may occur around the injection site and can last several days or weeks.
- Temporary tiny blood vessels may develop at the treated area. This is called revascularization, "flares," "mats," or "blushing." They may appear days or weeks after the procedure but should fade within a few months and usually do not require further treatment.
- Allergic reactions to the sclerosing agent may occur 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, please contact your physician immediately:
- Inflammation (swelling) within five inches of the groin.
- Sudden appearance of a swollen leg.
- Formation of small ulcers at the injection site.
- Red streaking, especially in the groin area.
Recovery and Outlook
How will I feel after the sclerotherapy procedure?
You may feel mild discomfort when the veins are injected, and a cramping sensation for 1 to 2 minutes when larger veins are injected.
Will my insurance cover sclerotherapy?
Insurance companies do not provide coverage for sclerotherapy when it is performed for cosmetic reasons. Some insurance companies cover sclerotherapy for specific medical conditions. Your insurance company may request a letter from your physician concerning the nature of your treatment. Please contact your insurance provider to verify coverage before you consider the procedure.