Sclerotherapy is a medical procedure whereby a chemical, the sclerosant, is injected into a vein to entirely obliterate it. The sclerosant damages the innermost lining of the vessel, resulting in a clot that blocks the blood circulation in the vein beyond. Veins carry unoxygenated blood from the peripheral tissues back to the heart. Since the blood pressure in the veins is low, the blood is pumped by forward by contractions of the heart. To prevent back-flow, most veins have valves that only allow blood only to flow in the direction of the heart. When these valves become incompetent, veins become enlarged and bulging (varicose). Smaller veins that feed these varicose veins can also become enlarged and appear as red or blue spider veins in the skin. Varicose veins can lead to a chronic swelling condition of the leg called venous insufficiency. Venous insufficiency predisposes a person to blood clots and skin ulceration. Even more frequently, damaged veins are manifested as unsightly spider veins. The destruction of these types of veins can be desirable both medically and cosmetically.
When to Consider Sclerotherapy
- Spider veins and small veins that are not causing more serious problems.
- Smaller varicose veins that come back after vein-stripping surgery.
- Larger varicose veins, when minimally invasive techniques are used.
Sclerotherapy is a procedure used to reduce the appearance of spider veins. It involves injecting a sclerosing agent or detergent into a vein using a fine needle. The solution irritates the lining of the vein causing it to stick together. Over time, the vessel will turn into scar tissue and fade.
Detailed Procedural Information
How is a Sclerotherapy procedure performed?
Sclerotherapy is the "gold standard" and is preferred over laser for eliminating large spider veins (telangiectasiae) and smaller varicose leg veins. Unlike a laser, the sclerosing solution additionally closes the "feeder veins" under the skin that are causing the spider veins to form, thereby making a recurrence of the spider veins in the treated area less likely. Multiple injections of dilute sclerosant are injected into the abnormal surface veins of the involved leg. The patient's leg is then compressed with either stockings or bandages that they wear usually for two weeks after treatment. Patients are also encouraged to walk regularly during that time. It is common practice for the patient to require at least two treatment sessions separated by several weeks to significantly improve the appearance of their leg veins.
Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the great and small saphenous veins. After a map of the patient's varicose veins is created using ultrasound, these veins are injected whilst real-time monitoring of the injections is undertaken, also using ultrasound. The sclerosant can be observed entering the vein, and further injections performed so that all the abnormal veins are treated. Follow-up ultrasound scans are used to confirm closure of the treated veins, and any residual varicose veins can be identified and treated.
What are my options?
Sclerosants include the following:
- Detergents-Disrupt vein cellular membrane (protein theft denaturation)
- Osmotic agents- Damage the cell by shifting the water balance through cellular gradient (osmotic) dehydration and cell membrane denaturation
- Chemical irritants- Damage the cell wall by direct caustic destruction of endothelium
Preparing for Your Procedure
How do I prepare for a Nail Clinic procedure?
Patients are screened using special ultrasound techniques to determine the site of venous disease prior to treatment. In situations where there is only a small area of spider veins, this is rarely done.
In advance of your procedure, your surgeon will ask you to:
- Stop smoking at least six weeks before undergoing surgery to promote better healing.
- Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
Aftercare and Recovery
Patients should wear compression dressings for one to three weeks after treatment. A follow-up visit within two weeks to enable the evacuation of blood clots in larger veins can improve the prognosis and the appearance.
- Normal symptoms you will experience.
- Potential signs of complication.
After sclerotherapy, treated veins tend to fade within a few weeks, although occasionally it may take a month or more to see the full results. In some instances, several sclerotherapy treatments may be needed.