What is Sclerotherapy?
Sclerotherapy is a medical procedure used to treat spider veins, reticular veins, and some varicose veins. Sclerotherapy involves an injection solution (either a salt or detergent solution) directly into the vein. In larger, deeper veins, ultrasound guidance is used.
The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot. Over time, the vessel turns into scar tissue that fades from view and is absorbed by the body.
Sclerotherapy is a proven procedure and has been in use since the 1930s.
Candidates for Sclerotherapy
Prior to sclerotherapy, you will have an initial consultation with your specialist who will decide if you’re a good candidate for the procedure.
You are not eligible if you are pregnant. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be decided on an individual basis, and will depend on the overall health of the area needing treatment as well as the reason for the clot.
Types of Treatment
Standard Ultrasound-Guided Sclerotherapy
Ultrasound-guided sclerotherapy uses duplex ultrasound technology to locate diseased vein not visible to the naked eye. An experienced technician or surgeon maps out the veins to determine precisely which veins need injections and which veins are best left alone. Using hi-resolution duplex ultrasound, doctors can determine how many injections are required. Next, we inject sclerosant solution into the vein to irritate the vein lining. This causes the vein to close and shrink. Eventually, the vein disappears altogether. It is largely a painless procedure, using a very small needle.
Ultrasound guided sclerotherapy is particularly advantageous for those who have already undergone varicose vein surgery once and have recurring veins. Using ultrasound, the doctor can pinpoint the exact cause of the recurring veins. Treatment with ultrasound guided sclerotherapy helps to avert complications such as blood clots, leg ulcers, and dermatitis, in addition to relieving bothersome symptoms like aching, swelling, and tiredness. The success of treatment depends on how well backward flow points are controlled. It is also best for veins in areas that are too sensitive to laser or radio-frequency ablation, like the very low part of the leg close to the ankle.
ICE Sclerotherapy is a combination of therapies grouped together to produce optimal results with minimal pain, pioneered by Dr. David A. Greuner of NYC Surgical Associates, and used throughout our clinics in the NYC metro area with excellent results vastly superior to traditional sclerotherapy.
The two most common problems with sclerotherapy that can be avoided with Dr. Greuner’s technique are initial pain of the needle, and post procedure bruising.
By using cryotherapy (cooling of the skin) with an additional agent that causes increased contraction of the blood vessel, as well as an FDA approved sclerosing solution, we are able to make sclerotherapy much more effective.
We are also able to minimize pain, and lessen bruising, because the vein is more contracted after the procedure. It closes more effectively, and has less blood in it to cause bruising and discoloration.
Not every patient is a candidate for ICE sclerotherapy, but most are. Find out how we can help you get the best results with minimal pain and bruising today.
No Needle Sclerotherapy
Electrocoagulation is sometimes called diathermy electrolysis. This procedure works by the passage of electric current through the skin using a needle that causes heat to be generated. This heat produced by the current destroys the blood vessel. It is worth noting that although other vessels can form, the ones that are treated with electrolysis will never re-emerge again. There is no need for anesthesia with this procedure, and results are instant. Vessels generally treated by this method are too small to be treated with sclerotherapy. Your surgeon will help you decide which method is best for your particular problem.
Sclerotherapy does not require any major preparation. If you are on blood thinning medications or have a dark sun tan, or plan on doing so, you should discuss this with your doctor prior to treatment.
Basic Facts to Know
The healing process can be quite long.
Sclerotherapy works by irritating the inside of the vein treated. This causes a small (nondangerous) blood clot. The healing process involves your body absorbing this clot, which is entirely dependent on your individual body and varies per patient. Once the clot is absorbed, the vein is gone.
This also means, that the bigger the vein, the more inflammation takes place. Sometimes mild tenderness is present at the area for a few weeks. In larger veins covered by very thin skin, sometimes the clot can burst through the thin layer, but heals with time.
Often, in larger spider veins, there is a mild residual brownish discoloration at the injection site. This is from iron from the blood breaking down in the skin. It is temporary, but can take up to 2 years to resolve depending on the patient.
Most veins take more than one treatment to obtain optimal results.
In fact, the average number of sclerotherapy treatments nationwide is between two and six. Treatment is administered every 2-6 weeks depending on the patient. It is rare that results are optimal with only one treatment, and very few require more than six. Your doctor will go over an estimate based on your condition about the time and number of treatments required, but it will vary from 2 months in mild cases to up to 12 months in very severe cases to get you looking great. Be patient, and we will get you where you need to be.
It is not unusual for patients to think their spider veins have gotten worse after one treatment. This is not the case.
Usually, the vein is simply irritated, and needs further treatment. Please be patient and follow up as instructed by your doctor to monitor your progress.
You need to avoid unnecessary skin irritation during the course of your sclerotherapy treatment.
This includes suntanning. Normal sun exposure is fine. Sclerotherapy treatment is popular in colder months (when legs are covered) for cosmetic reasons.
Sclerotherapy is curative for the veins treated.
They normally do not reopen if they are treated to completion. It does not however, prevent new veins from forming, which happens with time.
Sclerotherapy also does NOT worsen existing veins or cause more spider veins to form.
Some patients, but not all, will need to wear compression hose after treatment.
This is typically no longer than 5 days. Your doctor will make recommendations based on clinical assessment.
Common Side Effects of Sclerotherapy
You may experience certain side effects after sclerotherapy. There are milder effects, such as itching, which can last for one or two days after the procedure. Also, you may experience raised, red areas at the injection site. These should disappear within a few days. Bruising may also occur around the injection side and can last several days or weeks.
Additional (Rare) Side Effects
- Larger veins injected may become lumpy and hard, and may require several months to dissolve and fade.
- Brown lines or spots may appear at the vein site. In most cases, they disappear within three to six months, but they may also last longer.
- Neovascularization — the development of new, tiny blood vessels — may occur at the site of sclerotherapy treatment. These tiny veins can appear days or weeks after the procedure, but should fade within three to twelve months without further treatment.
Should any of the following side effects occur, contact your doctor immediately. These include:
- A sudden onset of a swollen leg
- Formation of small ulcers at the injection site.
Allergic reactions to the fluid injected is uncommon but may occur. Fluid reactions are rarely serious.
If you have a history of allergies, you have a greater chance of experiencing an allergic reaction to the agents. A minor allergic reaction will cause itching and swelling.
If you have a history of allergies, alert your treating physician. To avoid any serious complications, your doctor will likely test the agents on a small area before applying the solutions to a larger area.
After sclerotherapy you will be able to drive yourself home and resume your regular daily activities. Walking is encouraged.
Following the injections, avoid aspirin, ibuprofen, or other anti-inflammatory drugs for at least 48 hours. Tylenol may be used if needed.
You should avoid suntanning while your treated veins are healing, which can take several weeks depending on the size.
Studies have shown that as many as 50%-80% of injected veins may be eliminated with each session of sclerotherapy. Most patients that need treatment need between 2-6 sessions depending on the amount of veins to treat and the size.
Less than 10% of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions can be explored. Although this procedure works for most patients, there are no guarantees for success.
In general, spider veins respond in three to six weeks, and larger veins respond in three to four months. If the veins respond to the treatment, they will not reappear. However, new veins may appear at the same rate as before. If needed, you may return for injections.
Your surgeon will discuss the best option for you after an examination and consultation. Sclerotherapy using Polidocanol is quick, painless, very effective, and permanent for the veins treated. It obtains excellent results in the right patient. So what are the downsides?