Sclerotherapy
What is Sclerotherapy?
Can Sclerotherapy be performed in clinic?
Does Sclerotherapy work for everyone?
Will treated veins recur?
Will I see immediate results?
How many treatments are required?
Is Sclerotherapy painful?
Are there any side effects with Sclerotherapy?
Are there any contraindications to sclerotherapy?
Are "medical" stockings needed after treatment?
Will insurance pay for Sclerotherapy?
What is Sclerotherapy? Sclerotherapy refers to injections of a sclerosing (irritating) liquid into varicose or spider veins using tiny needles. The solution pushes the blood out of the vein, initially causing it to blanch. The vein collapses, closes down and then disappears over time.
Can Sclerotherapy be performed in clinic? Yes, Sclerotherapy is a simple procedure performed in clinic that requires no anesthesia.
Does Sclerotherapy work for everyone? The majority of people who have Sclerotherapy will have pleasing results. In very rare cases, conditions may become worse after treatment.
Will treated veins recur? After treatment, spider veins may appear again in some patients. Approximately 10% of veins treated persist after multiple treatments. Additional treatments may be required; some veins do not respond to Sclerotherapy, and new spider veins can develop near the site of a previous injection.
Will I see immediate results? After several treatments most patients can expect 50-90% improvement. However, fading is gradual, usually over several months, with complete disappearance achieved in most cases.
How many treatments are required? The number of treatments will vary for each patient, depending on the size and number of veins involved. Several veins can be injected at each session. One to six treatments may be needed, but the average is three to four. Treatment plans are patient specific and are agreed upon by you and your vein specialist.
Is Sclerotherapy painful? The procedure is usually associated with minimal discomfort. A burning or stinging sensation at the time of injection may be felt. This discomfort usually resolves within minutes. Treated veins will usually turn red before fading which is caused by localized inflammation and may be associated with some persistent pain. Most are able to return to their normal routine right after their treatment session with minimal discomfort.
Are there any side effects with Sclerotherapy? A discussion with the clinician of your concerns and expectations from the procedure is important. Occasional side effects do occur even with highly trained clinicians providing your care. They can include the following:
- Pain
You should expect to have mild to moderate discomfort. Pain is experienced by everyone, but the level of discomfort varies. During the procedure, pain is due to the injection and is often described as a bee sting. After the procedure, pain is usually from the intended inflammatory sclerosing process. If the sclerosing agent leaks outside the treated vein there can be more pain at the injection site. Most discomfort resolves within 24 hours of the treatment.
- Swelling
Swelling at the injection site is common, but variable. It is usually due to the injection and inflammatory response and will usually resolves within 1-2 days after injection.
- Bruising
Bruising is common after needle injections when a small amount of blood leaks into the surrounding tissue. This is more common when deeper veins are injected. It should resolve in 3-4 days.
- Bleeding
For those without bleeding disorders, a small amount of bleeding (droplets) can occur, but is easily controlled with pressure dressings.
- Matting (fine red lines)
Matting is residual fine “hair-like” spider veins that can occur after multiple injections. Additional consultation may be indicated if this side effect is persistent with consideration for surface laser removal.
- Hyperpigmentation (brown lines or spots)
Hyperpigmentation is any brownish staining of the skin occurring after sclerotherapy caused by residual iron pigmentation from absorbed blood cells. In most patients this condition resolves within 6-12 months, but in 1-%-2% of patients it can persist after one year.
- Ulcers/Infections/Scarring
Ulcers and infections can sometimes develop at the injection site. This occurs when the sclerosing agent leaks into the surrounding tissue, from allergic reactions to the sclerosing agent or from dressing problems (tape abrasions). An ulcer can occur up to two weeks after injection. Scarring from the ulcer may be permanent.
- Recurring Varicose Veins
Sclerotherapy is not a cure for varicose and/or spider veins. New ones can occur even in areas previously treated. Previously treated veins may return if there is an underlying large vein abnormality which may require more invasive surgical procedures.
- Allergic Reactions/Itching
Local reactions to the sclerosing agent will look like hives surrounding the injection site. There could also be a local reaction to tape or the compression hose. This type of reaction may last several days. Rarely, a generalized systemic anaphylactic life-threatening reaction can occur.
- Hematomas
Hematomas are an accumulation of blood underneath the skin that feels like a “lump”. They can be painful, warm, and red. If large enough, they may need to be drained.
- Vasovagal Reflex
The vasovagal reflex is a common side effect of any invasive procedure. It presents with light-headedness, nausea, sweating, and occasional shortness of breath and palpitations.
- Superficial Thrombophlebitis
This is an inflammatory and clotting reaction that appears as a tender, warm and red area over an injected vein. It can occur up to 3 weeks after injection and can sometimes be associated with infection of the vein.
- Deep Venous Thrombosis
Occurs when a clot forms and moves into the deeper veins of the legs. The clot has the potential to become dislodged from the leg and travel up to the lungs (“pulmonary embolus”) causing shortness of breath, anxiety, chest/back pain and even death. Fortunately, this is a rare complication of scleroterhapy.
- Localized Hypertrichosis
Hypertrichosis is a temporary increase of hair growth at the injection sites, occurring 4-8 months after injection. This represents a natural response of your body to the injections and is not directly related to the sclerosing agent. This reaction is even less common when hypertonic saline is used.
- Vasospams
Rarely, after injection of a sclerosing agent, an immediate porcelain-white appearance is noted at the site of injection and represents vessel spasm. Most vasospasms are transient, but if it persists, an ulcer can form. This reaction is not common when hypertonic saline is used.
- Arteriolar Injection
Inadvertent arteriolar injection can cause sudden leg pain during the injection. This can lead to ulceration, loss of tissue, nerve damage and possibly limb or life-threatening problems. Fortunately, this is a rare complication and with proper precautions it can be avoided.
Are there any contraindications to sclerotherapy? There are few absolute contraindications to sclerotherapy, but there are some medical conditions that warrant either postponing or proceeding with caution. Please notify the vein nurse if you have any of these conditions.
- Pregnancy/Nursing
- Prolonged Bleeding Diseases
- Connective Tissue Diseases ( Ehlers-Danlos syndrome)
- Arterial Diseases
- Diabetes
- Immune Compromised States
- Heart/Kidney/Liver Disease
- History of Keloid Formations
- Medication, Tape or Latex Allergies
- Previous Adverse Reactions to Sclerotherapy
Are "medical" stockings needed after treatment? To get the best results from sclerotherapy, it is important to wear compression stockings. A prescription will be provided before your session.
Will insurance pay for Sclerotherapy? The cost for sclerotherapy is usually not covered by insurance and will not be billed to your insurance company. The UAB Vein Clinic fee schedules will be made available prior to treatment.
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