Information on Sclerotherapy

What is sclerotherapy?

Sclerotherapy is a method of elimination dilated skin capillaries known medically as varicose veins or superficial telangiestasias ("spider veins"). These vessels may become unsightly with time and may also lead to a dull aching of the legs after prolonged standing.

In sclerotherapy, a sclerosing agent is instilled into these vessels using a small needle. The solution irritates and destroys the inner lining of the blood vessel so it ceases to carry blood. The body then replaces this damage vessel with imperceptible scar tissue. This does not harm the circulation - it improves it by eliminating the abnormal, unnecessary vessel.

Does sclerotherapy work for everyone?

The majority of persons who have sclerotherapy performed will be cleared of their varicosities or at least see improvement. Unfortunately, however there is no guarantee that sclerotherapy will be effective in every case. Approximately 10 percent of patients who undergo sclerotherapy have poor to fair results. ("Poor results" means that the veins have not totally disappeared after six treatments) in very rare instances, the patient's condition may become worse after sclerotherapy treatment.

How many treatments will I need?

The number of treatment needed to clear or improve the condition differs from patient to patient, depending on the extent of varicose and spider veins present. One to six or more treatments may be needed; the average is three to four.

Fading of the vessels is a slow process that takes one to six months. The goal is to produce a 75 percent to 90 percent improvement. However, as previously stated, the results of the treatment cannot be guaranteed.

How often can I be treated?

The same area should not be injected again for three to four weeks to allow for complete healing.

What are the most common side effects?

Itching. Depending on the type of solution used, you may experience mild itching along the vein route. This itching normally lasts one to two days.

Transient hyperpigmentation. In almost every patient, the veins become darker immediately after the procedure. In rare instance, this darkening of the vein may persist for 4 to 12 months. Approximately 10-30 percent of patients who undergo sclerotherapy develop a small freckle-like tan to brown spot around the injected vessel. This resolves in 80 percent of the patients within three to six months. A few patients will have a persistent freckle for up to a year.

Blistering. Slight blistering may occur around the injected vessels and resolves in a day or so.

Sloughing. Sloughing occurs in less than 3 percent of patients who received sclerotherapy. Sloughing consists of a small ulceration at the injection site that heals slowly. A blister may form, open, and become ulcerated. The scar that follows should return to a normal color. The rare severe "sloughs" produce small permanent depressed scars.

Allergic reactions. Very rarely, a patient may have an allergic reaction to sclerosing agent used. The risk of an allergic reaction is greater in patients who have a history of allergies. The agent commonly used "Sotradecol" TM® is a sulfa derivative.

Pain. A few patients may experience moderate to severe pain and some bruising, usually at the site of the injection. The veins may be tender to the touch after treatment, and an uncomfortable sensation may run along the vein route. This pain is usually temporary, in most cases lasting one to, at most, seven days.

What are the other side effects?

1. Other side effects are a burning or stinging sensation during injection of some solutions, transient phlebitic-type reactions (swelling of the vein might cause the ankles to swell), temporary superficial blebs or wheals (similar to hives), and , very rarely, wound infection, poor healing, or scarring.
2. Sometimes a clot develops at the injection site (especially if the recommended bandages are not worn for the proper amount of time). This clot will never cause internal problems.
3. Swelling over the injection site may rarely occur. It is most common when patients have jobs in which they stand for long periods of time when vessels in the ankles are injected. The swelling is never dangerous but occasionally must be treated with elevation and compression dressings.
4. Superficial thrombophlebitis, an irritation of the injected vessel, occurs in less than 1 per 1000 patients. It may have to be treated with anti-inflammatory agents and compression stockings.
5. Deep vein phlebitis is extremely rare with injections. The best way to avoid this is walking and being active. Risk factors include immobility, obesity, smoking and trauma. Phlebitis is a very rare complication seen in approximately 1 of every 100 patient treated for varicose veins greater than 3 to 4mm in diameter. The dangers of phlebitis include the possibility of pulmonary embolus (a blood clot to the lungs) and psotphlebitic syndrome (the blood clot is not carried out of the legs) resulting in permanent swelling of the legs.

Are there other methods of treating these vessels?

Three other methods are used:

Laser Surgery. This method is very effective for tiny facial blood vessels. The present laser systems can only treat limited areas and very superficial veins. The laser is an expensive device and treatment is thus more costly.

Vein stripping and/or ligation. This method is used to treat large varicose veins. This is done in a hospital operation room while the patient is under spinal anesthesia. Risks of vein stripping or ligation include nerve numbness, pulmonary emboli, infection, and permanent scarring. These complications are infrequent.

Closure Technique. Closure of large thigh veins with minimal or no incision done in the operating room with a radiofrequency emitting catheter eliminates large veins with less scarring than vein stripping.

What should I do before my appointment for treatment?

Nothing medically needs to be done. However, you should check with your insurance company as the cost of the procedure may not be covered depending on the type of vessel treated and the type of insurance coverage you have. You should also ask your insurance company if they require pre-authorization for the procedure to be covered.

What is the cost of the procedure?

The cost of the procedure is $150-300 depending on the treatment.

Again you should check with your insurance company to be sure they will cover the procedure and to determine if pre-authorization is necessary.

What should I do after the procedure?

The bandages will need to stay in place for two days to one week depending on the size of the veins that have been injected. The physician will let you know the duration of time for the bandages at the time of treatment. The bandages should not get wet. We encourage walking and normal activities of daily living. However, you will probably not want to engage in aerobics while the dressings are on. Power walking or treadmills are acceptable. You may need to periodically elevate you leg throughout the day above heart level if the bandage becomes tight as your leg swells during the day with walking or standing.

What causes spider veins?

No one is totally sure. Certain families are predisposed to this condition, particularly female relatives. Certain things make spider veins worse: estrogens, pregnancy, birth control pills, tight girdles and garter belts, prolonged standing or siting, and trauma.

Is there any way to prevent them?

The use of support hose may be helpful. Reducing your weight and regular exercise may also be of help.

Are there certain types of spider veins that can't be treated?

Certain types of spider veins may not respond readily to sclerotherapy alone. These vessels may require laser therapy.

Do recurrences occur?

Recurrence may rarely occur over a period of one to five years. This treatment does not prevent new telangiectasias from developing.