Sclerotherapy

What is sclerotherapy?

Sclerotherapy is a medical procedure used to treat varicose veins and “spider veins.” During sclerotherapy, the physician injects a solution directly into the affected vein. The solution irritates the lining of the vessel, causing it to swell and stick together. Over time, the vessel turns into scar tissue that fades from view. Sclerotherapy is a well-proven procedure and has been used since the 1930s.

How is sclerotherapy done?

Sclerotherapy at our office is performed in the MPR (Minor Procedure Room). The treatment area is cleansed. The solution is injected directly into the blood vessel, using very fine needles.

The number of veins injected in one session is variable, depending on the size and location of the veins, and the patient’s overall medical condition.The procedure itself takes approximately 30 minutes. You should plan to wear shorts during the injection.

How will I know if I am a candidate for sclerotherapy?

Before the procedure, you will have an initial consultation with Dr Lopez-Granja who will evaluate your eligibility for sclerotherapy. In some cases, a duplex or doppler ultrasound will be needed to establish the optimal course of treatment.

You are not eligible for sclerotherapy if you are pregnant, breastfeeding, or are bedridden. You must wait at least three months after delivery before you can be considered for this procedure. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be determined on an individual basis, and will depend on the extremity and the cause of the clot.

Veins that are potentially usable for future surgical bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery) will generally not be considered for injection, unless they are already deemed unusable.

What you need to do before the procedure?

Prior to vein injection, you should avoid certain medications. Tetracyclines, an antibiotic class, may possibly cause a staining of the skin if taken seven to 10 days before or after sclerotherapy. If you need to take an antibiotic before sclerotherapy, contact your physician. No lotion should be applied to the legs before the procedure.

Some physicians recommend avoiding aspirin, ibuprofen (i.e., ®Advil and ®Nuprin) or other anti-inflammatory medications for 48-72 hours before sclerotherapy to minimize bruising. Tylenol, however, should not affect this procedure.

Could sclerotherapy cause any side effects?

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.

Other side effects include:

• Larger veins that have been injected may become lumpy and hard and may require several months to dissolve and fade.
• Transient hyperpigmentation consists of brown lines or spots that may appear at the treatment vein sites. In most cases, they disappear within three to 12 months, but some pigmentation may take up to two years to fade.
• Neovascularization describes a temporary development of new, tiny blood vessels, also known as “matts,” or “blushing.” These tiny veins can appear days or weeks after the procedure, but should fade within 3-12 months without further treatment. If matts persist, they may be treated with vascular lasers.

Should any of the following side effects occur, contact your physician immediately. These include:

• Inflammation within five inches of the groin
• A sudden onset of a swollen leg
• Formation of small ulcers at the injection site

Allergic reactions to the sclerosing agents may occur at the time of the injection and 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. To avoid any serious complications, your doctor will test the agents on a small area before applying the solutions to a larger area if there is concern over a possible allergy to the agent.

If you have any concerns or questions following this procedure, you should contact your doctor.

What happens after the treatment?

After the treatment you will be able to drive yourself home and resume your regular daily activities. Walking is encouraged. You will be instructed to wear medical grade support hosiery to “compress” the treated vessels.  Your doctor’s office can recommend where to purchase heavy compression stockings.

Following the injections, avoid aspirin, ibuprofen or other anti-inflammatory medications for at least 48 hours. Tylenol may be used if needed.

Also, you should avoid the following for 48 hours after treatment:

• Hot baths
• Hot compresses
• Whirlpools or saunas
• Direct exposure to sunlight
• Weight lifting with the legs (should be minimized for two weeks)

Showers are permitted, but the water should be lukewarm. The injection sites may be washed with a mild soap and tepid water.

How effective is sclerotherapy?

Studies have shown that over 90 percent of patients see an improvement following a series of sclerotherapy sessions. Less than 10 percent of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions can be tried. 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,it is important to realize that sclerotherapy does not prevent development of new spider veins and varicosities over the years. Many people will require  treatments from time to time to keep their legs clear. Standing occupations, pregnancy and estrogen increase this tendency.