Introduction
Sclerotherapy is the technique of injecting a drug to treat varicose and spider veins. The drug, once inside the vein, damages the cells that line the vein, causing any residual blood to clot. The process causes a degree of inflammation and as the body breaks down the clot the vein slowly disappears. The drug can be injected as a foam to treat a variety of vein types and the procedure can be performed in the rooms without any anaesthetic requirements.
Indications
Sclerotherapy is ideal for isolated varicosities and surface (spider) veins. It is best used once any major venous incompetence has been dealt with by ablation therapy or vein stripping. It is ideal in patients who just have isolated visible surface veins. The procedure can be repeated as often as necessary to control the relevant veins.
Preoperative Instructions
It is important to bring the prescribed compression stocking for the treatment. The stockings need to be worn immediately after the injection treatment has finished. No fasting is required. It is useful to bring or wear a pair of shorts during the procedure. To minimise complications, it is important to walk for at least 30 minutes immediately after the procedure. Bringing suitable clothes and footwear to facilitate this is important.
Procedure
The procedure is performed in the rooms. No local anaesthetic is used, as the sclerosant is injected through very small needles and local anaesthetic tends to sting more than the sclerosant drug.
A series of injections are then performed to the relevant veins. Ultrasound guidance is sometimes used to help facilitate treating some of the deeper veins. The number of injections will depend on the number of varicose veins and how widespread they are.
The drug used is aethoxysclerol. Quite a large volume can be used however there is a dosage limit and at times very extensive varicosities will require treatment in multiple sessions. There are no dressings required after the procedure and the stockings are worn immediately.
Postoperative Instructions
Immediately post procedure a 30-minute walk is required to increase blood flow through the deeper veins and minimize the risk of Deep vein thrombosis (DVT). DVT is extremely rare following sclerotherapy, however it is important to take as much precautions as possible. Following that walk then it is safe to return to all usual activities. The stockings will be required for 7-14 days depending on the types of veins treated. This will be advised at the time of the procedure. A routine follow-up appointment will be arranged for 4-6 weeks post treatment.
Risks
Sclerotherapy is very safe. As with all procedures some complications can occur.
Potential complications include:
- Allergic reaction – any drug can potentially have an adverse reaction. This would necessitate the cessation of treatment and management of the reaction.
- Bruising.
- Bleeding.
- Deep vein thrombosis.
- Superficial thrombosis – the nature of the treatment does cause a degree of superficial thrombosis which can cause a red, hard lump. This will slowly disappear and is best treated with anti-inflammatories.
- Recurrent varicosities and need for further treatment.
- Vein matting – an uncommon development of new, very fine veins at the site of injections.
- Pigmentation – a brown skin discolouration at the site of injections which tends to fade with time but can leave a feint permanent are of pigmentation at the site of the injected veins. The darker the original vein the more likely this is to occur.
Treatment Alternatives
Unfortunately there are not many alternatives to sclerotherapy.
Disguising the veins with fake tan, make up or clothing is an option. Dermal laser treatments may help for very fine veins but is not very effective on larger more prominent veins.
Compression stockings may help reduce more veins developing but do not irradicate veins that have already developed.
Surgical treatment of any large underlying veins will help reduce the appearance of any surface veins.
Related Information
Endovenous Ablation of Varicose veins
Vein Stripping
Spider and Reticular Veins
Varicose Veins
Superficial Thrombosis
Venous Ulcers