Sclerotherapy

An effective treatment for unsightly veins.

Sclerotherapy is a microinjection procedure to treat veins (varicose, reticular or spider) in the legs that have become unsightly or cause pain and swelling. The procedure involves injection of a solution into the veins using a very fine needle. This solution irritates the vein lining causing it to undergo fibrosis and eventually disappear. Multiple veins can be injected at each treatment session. 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.

Sclerotherapy works well for most patients. It is estimated that as many as 50% to 80% of injected veins may be eliminated with each injection session. A few (less than 10%) of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions or a different method, such as laser therapy, may be tried.

In general, spider veins respond to treatment in three to six weeks, and larger veins respond in three to four months. If the veins respond to the treatment, usually they will not reappear. However, new veins may appear over time. If needed, you may return for injections.

Frequently Asked Questions:

 

What are Varicose and Spider Veins?

First, it’s important to understand the role of veins, 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 or as green veins (reticular). 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 or reticular veins. The destruction of these types of veins can be desirable both medically and cosmetically.

How do people prepare for the sclerotherapy procedure?

Patients are screened through their medical and surgical history, a review of current medications and then tested (at our clinic) with a special ultrasound. Please bring a pair of loose shorts to your appointment or wear under your clothes to be comfortable for the ultrasound and thorough examination of both legs.

What are spider veins?

Spider veins are most common in women in the age groups 30-50. This has been related to the hormone estrogen and pregnancy. Spider veins look like a network pattern in a circular fashion. These light purple veins usually appear in a lattice pattern and are completely harmless.

What are varicose veins?

Varicose veins are veins that have become enlarged and twisted. When veins become varicose, the valves do not work. This allows blood to flow backwards and they enlarge even more. Varicose veins are most common in the superficial veins of the legs, which are commonly related to jobs requiring prolonged standing, pregnancy, excess weight and genetics. Besides being a cosmetic problem, varicose veins can be painful, especially when standing. Severe long-standing varicose veins can lead to leg swelling, eczema, thickened skin and ulceration.

Where is the procedure done?

Sclerotherapy is done at a clinic with a doctor to assess and screen the potential patients and the procedure will be performed by a registered nurse. No anesthesia is required. With a very fine needle, the veins are injected with a medication (trombect or sclerodex) that will destroy the vein. There is minimal pain, a pin prick like sensation.

What medications are used for sclerotherapy?

TROMBOJECT®  is used in the treatment of varicose veins through injection by a registered nurse followed by compression therapy for up to six weeks. TROMBOJECT® causes a direct irritation of the inside of the vein, causing it to collapse and and form a thrombus, while compression therapy promotes the occlusion of the vein by fibrosis. SCLERODEX® is a relatively weak sclerosant used to treat spider veins causing them to coagulate and be absorbed by the body. If spider veins are the only veins being treated, compression therapy isn’t needed.

How many sclerotherapy treatments are required?

It varies from individual to individual but typically 2-4 treatments are required for the best results. In patients with milder cases, 1-2 will suffice. More treatments are required when there are more veins or slightly larger veins.

Do I have to limit any activity after the treatment?

Walking for 30 minutes is required right after the treatment to ensure the medication travels throughout the vein and good circulation is delivered to the treatment area. But, any high activity sports should be avoided for the first two to three days.

Does sclerotherapy hurt?

There is a little sting associated with each injection, lasting a few seconds. Most people tolerate the procedure very well and do not require any type of anesthesia. The majority of people claim that the procedure is much less than painful than what they anticipated.

What happens if spider veins are not treated?

Absolutely nothing. Spider veins are small veins which are entirely cosmetic. They do not form blood clots, they do not ache, and they do not cause swollen feet or pain. They will be treated with SCLERODEX® or a leg vein laser once all of the varicose an reticular veins are treated. Often, the successful treatment of the varicose and reticular veins removes the spider veins as well.

Can sclerotherapy be done on the arms or face?

No. Sclerotherapy should never be done on the face and hands. The hand veins may not look pretty at times, but they should never be treated. Azure can improve the appearance of your hands with intense pulse light therapy. If your facial veins are bothersome, our laser therapy is a better option.

Is there any harm in removing spider veins?

Spider veins have no function and removing does no harm. The only reason they are removed is for cosmetic reasons.

Can anyone undergo sclerotherapy?

Almost anyone with unwanted spider veins can be treated. A history of blood clots (deep vein thrombosis) and current treatment with warfarin or coumadin prevent you from having treatment. If you take NSAIDS or a baby aspirin you will be asked to stop for seven days pre and post treatment, to prevent bruising. Women who are pregnant or nursing can not be treated until you’ve had your baby and finished nursing. Other relative contraindications include: skin infections, uncontrolled diabetes, fever and corticosteroid use.

Is there any preparation required before sclerotherapy?

No preparation is required before the procedure. It is recommended that one stop smoking and stop taking aspirin and ibuprofen or naproxen one week before the procedure. Any patient on a blood thinner is not a candidate for sclerotherapy.

What happens after sclerotherapy treatment?

There is some mild pain which can easily be managed with Tylenol. The injected site will appear bruised and swollen for a few days. Wear your prescribed compression therapy as indicated (every day all day for four to six weeks) to relieve the swelling and pain and ensure your treatment is successful. The bruising disappears in two to three weeks. You will have no problem with walking, actually, it is encouraged to walk at least 30 minutes every day. After the first two days, you can resume your normal activities.

How long is each sclerotherapy session?

Each treatment session lasts up to 30 minutes. After the treatment, sterile dressings are placed over the injection site and the entire treatment area is covered with compression stockings and/or a compression dressing.

When can the treatment be done?

Sclerotherapy is an elective procedure and can be done whenever you’d like. The procedure does not take more than 30-60 mins and can even be done during an office lunch break.

What are side effects of sclerotherapy?

Besides some stinging pain, sclerotherapy can rarely cause a few side effects. Allergic reactions are extremely rare. The most common side effect is itching at the injection site. If the chemical is injected outside the vein,  discolouration and pain may occur. Additionally, intense sun exposure before all of the bruising is gone may result in discolouration. The collapsed varicose veins could take up to six months to be completely dissolved by the body. Note, the varicose veins will be gone after treatment, however, the coagulated blood within them may remain for this time period, feeling like a firm old bruise. Massage over the site will help the body absorb the dead tissue.

Does insurance cover sclerotherapy?

Unfortunately, spider veins are considered cosmetic in nature and not covered by OHIP or most private insurance. However, some varicose treatments are covered by OHIP and most are covered by private insurance. The cost of the treatments will be discussed and a quote will be provided at the consultation with the physician and registered nurse.