Sclerotherapy

Sclerotherapy is a procedure used to treat varicose and spider veins in the legs.


Indications
Varicose veins develop when veins or valves in the veins weaken, causing pooling of blood that leads the veins to bulge. They can become painful and unsightly. Spider veins are tiny veins that form a starburst pattern on the skin's surface.
Varicose and spider veins are much more common in women than men, especially women who've been pregnant. People who have a family history of varicose and spider veins have a higher risk of developing them.

Sclerotherapy may be appropriate if you're bothered by the appearance of varicose or spider veins. It's best for small, unsightly veins, dilated superficial veins, or varicose veins that recur or persist after vein stripping surgery. The procedure can also treat symptoms of varicose veins, including leg swelling, pain, burning, aching, and restless or heavy legs.

Sclerotherapy is most effective for people who have spider veins or relatively few or small varicose veins. The procedure may not be suitable for women who are pregnant or nursing or people who:

have a history of deep vein thrombosis (a blood clot deep inside a blood vessel), thrombophlebitis (inflammation of a vein caused by a blood clot) or a clotting disorder
have a history of pulmonary embolism (blocking of a blood vessel in the lungs by a blood clot, air bubble, fat deposit or other foreign substance)
have a history of severe allergies to the products used during the treatment
won't be able to walk immediately after the procedure
have diabetes or severe asthma
are severely obese
To decide whether sclerotherapy is right for you, consult your doctor.


Patient preparation
Look for a doctor who has solid training and experience in sclerotherapy. Always talk with your primary doctor, too, who may have advice about your overall medical condition in terms of this procedure, as well as advice about specialists. Make sure you understand the risks and benefits of sclerotherapy before signing a consent form for the procedure. Also, tell the doctor about any drug allergies or sensitivities you have, including sensitivities to topical medications (those applied to the skin). Be sure to follow any specific instructions given by the doctor.

Procedure
Sclerotherapy is done in the doctor's office on an outpatient basis. Using a very small needle, the doctor will inject sclerosing solution into the affected vein. Ultrasound imaging may also be used to help guide placement of the needle in the vein. The sclerosing solution irritates the lining of the blood vessel, making it inflamed and sticky. You may have muscle cramps, itching or pain at the injection site. These should fade within 10 to 15 minutes of the injection.
Next, the doctor will wrap compression bandages around your leg. These bandages (often elastic bandages or stockings) will help the vein walls stick together and route blood flow to healthier veins. The vein will become scar tissue within a few weeks, be absorbed by the body and eventually fade from view.


Postprocedure care
After the procedure, you'll need to wear the compression bandages 24 hours a day for at least three days and potentially up to three weeks after treatment. Ask your doctor about any other restrictions and when to schedule a follow-up visit. Call the doctor right away if you develop blisters or skin lesions.

Benefits
Sclerotherapy is less expensive than surgical vein removal, less invasive and has fewer complications. You're able to walk immediately after the procedure and the overall recovery period is shorter.

Risks
Multiple sclerotherapy sessions are generally needed to effectively treat a vein, but several veins can be treated in a single session. Localized hives are a common reaction to the sclerosing solution, but they usually subside within one to three hours. Minor bruising, swelling and soreness may also occur. Your skin may be permanently stained with brown spots at the site of the treated vein, although such pigmentation usually resolves within weeks. Rarely, an allergic reaction to the sclerosing solution may occur, or skin sloughing can create chronic sores. There is also a small risk of developing blood clots. Although varicose veins have a greater chance to recur with this procedure than surgical vein removal, newer techniques are improving the success rate for removal of unsightly veins.

Considerations
Sclerotherapy may cost a few hundred to several thousand dollars, depending on how many sessions are required. Most insurance companies don't cover the procedure when it's done for cosmetic reasons only. Be sure that you understand your insurance coverage and understand whether sclerotherapy is considered medically necessary for you before undergoing the procudure.

Pregnancy-specific information
When you're pregnant, the increased weight of the uterus may compress certain veins, creating added pressure in the veins. If you have a history of varicose veins or spend a lot of time on your feet, wear elastic support stockings. Sclerotherapy is generally not done during pregnancy.

Senior-specific information
Varicose veins are common in elderly adults. In fact, studies have shown that more than 70 percent of women ages 60 to 70 have varicose veins. More than 40 percent of 70-year-old men are affected. Consult your doctor about the best treatment approach for you.