What's in this article?
What is sclerotherapy?
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.
Sclerotherapy is often done for:
- Cosmetic purposes – to improve the appearance of varicose and spider veins
The procedure also can improve related symptoms such as:
- Night cramps
If you’re pregnant or breast-feeding, doctors recommend waiting to have sclerotherapy done.
Is sclerotherapy safe?
Sclerotherapy is a fairly safe procedure with few complications.
Temporary side effects
Some side effects that may occur at the site of the injection include:
- Raised red areas
- Small skin sores
- Darkened skin in the form of lines or spots
- Multiple tiny red blood vessels
These side effects usually go away within a few days to several weeks. Some side effects can take months or even years to disappear completely.
Side effects that may require treatment
Other complications are less common but may require treatment. These include:
- Inflammation. This is usually mild but may cause swelling, warmth and discomfort around the injection site. Your doctor may suggest aspirin to reduce the inflammation.
- Blood clot. A lump of clotted blood may form in a treated vein that may require drainage. Rarely, a blood clot may travel to a deeper vein in your leg (deep vein thrombosis).Deep vein thrombosis carries a risk of pulmonary embolism (a very rare complication of sclerotherapy), an emergency situation where the clot travels from your leg to your lungs and blocks a vital artery. Seek immediate medical care if you experience difficulty breathing, chest pain or dizziness, or you cough up blood.
- Air bubbles. Tiny air bubbles may rise in your bloodstream. These don’t always cause symptoms, but if they do, symptoms include visual disturbances, headache, fainting and nausea. These symptoms generally go away, but call your doctor if you experience problems with limb movement or sensation after the procedure.
- Allergic reaction. It’s possible that you may have an allergic reaction to the solution used for treatment, but this is uncommon.
How do people prepare for the sclerotherapy 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.
During the procedure
For the procedure, you’ll lie on your back with your legs slightly elevated. After cleansing the area to be treated with alcohol, your doctor will use a fine needle to slowly insert a solution into the appropriate vein.
The solution, usually in liquid form, works by irritating the lining of the vein, causing it to swell shut and block the flow of blood. Some solutions contain a local anesthetic called lidocaine.
Eventually, the vein will become scar tissue and disappear. Sometimes a foam version of the solution may be used, particularly when a larger vein is involved. Foam tends to cover more surface area than liquid.
Some people experience minor stinging or cramps when the needle is inserted into the vein. If you have a lot of pain, tell your doctor. Pain may occur if the solution leaks from the vein into surrounding tissue.
Once the needle is withdrawn, your doctor applies compression and massages the area to keep blood out of the injected vessel and disperse the solution. A compression pad may be taped onto the injection site to keep the area compressed while your doctor moves on to the next vein.
The number of injections depends on the number and size of veins being treated.
After the procedure
You’ll be able to get up and walk around soon after the procedure. Walking and moving your legs is important to prevent the formation of blood clots.
You’ll be asked to wear compression stockings or bandages — usually for about two weeks — to maintain compression on the treated veins.
Most people return to their normal activities on the same day, but it may be wise to have someone drive you home after the procedure. Your doctor will probably advise you to avoid strenuous exercise for two weeks after the procedure.
You’ll also want to avoid sun exposure to the treated areas during that time. The inflammation caused by the injections combined with sun exposure can lead to dark spots on your skin, especially if you already have a dark skin tone.