Varicose veins are enlarged, swollen, twisted veins that usually occur in the legs. They are caused by faulty valves in the veins that cause the pooling of blood in the lower extremities. Spider veins are a milder form of varicose veins that appear close to the skin's surface on the legs or face. They are not usually painful or harmful. However, in some people varicose veins and spider veins need to be treated for cosmetic or medical purposes. Sclerotherapy is a safe and effective treatment for varicose veins. Please continue reading to learn more about sclerotherapy treatment, including what the treatment session involves, the side effects, costs, and more.
What is sclerotherapy for varicose and spider veins?
Sclerotherapy is a medical procedure that has been used to treat varicose veins and spider veins since the 1930s. It involves injecting a chemical solution directly into the affected veins. The solution leads to the formation of scar tissue in the damaged veins, closing them off. The blood is re-routed through healthier veins in the area. The treated veins tend to be gradually reabsorbed. As a result, veins treated with sclerotherapy fade over a few weeks to months.
Spider veins respond well to sclerotherapy. This procedure is often the first choice of treatment for smaller varicose veins. Larger varicose veins may require further treatment with additional sclerotherapy sessions to see results.
How does sclerotherapy work? Is it effective?
Sclerotherapy is an effective treatment for varicose veins and spider veins. As noted above, sclerotherapy involves injecting a solution into the affected veins. This irritates the lining of the blood vessel, causing it to form scar tissue. The injected vein collapses and fades away over time, forcing blood to flow through healthy veins.
Studies show that 50%-80% of varicose veins can be eliminated with a single session of sclerotherapy. In less than 10% of people, the injected veins do not respond at all. In such cases, a different sclerosing agent can be tried.
While sclerotherapy works for most people, it is important to have varicose veins and spider veins medically reviewed. The procedure may not be right for everyone. Also, success is not guaranteed.
Who is a candidate for sclerotherapy?
Sclerotherapy is done for two reasons. The first is cosmetic - to improve the appearance of varicose and spider veins. The second is to provide relief from symptoms such as pain, swelling, itching, burning, cramps, and other related symptoms. You may be a candidate for sclerotherapy of varicose veins if you fall into either of these categories.
Your doctor may ask you to delay sclerotherapy treatment if you are pregnant or breastfeeding. You can have this procedure done if you are on birth control pills. However, if you have had a blood clot in the past, your eligibility for sclerotherapy will be decided by a dermatologist or vascular medicine doctor on an individual basis.
Lastly, large varicose veins that may potentially be needed for heart bypass surgery in the future are generally not considered for sclerotherapy (unless they are unstable).
What areas can sclerotherapy treat?
Sclerotherapy can be done on the thighs, calves, ankles, feet, face, and sometimes even the anus. Varicose veins most commonly develop on the legs and feet. They can be raised and discolored and cause pain and itching. Spider veins tend to be closer to the skin's surface and may appear red, blue, or purple, occurring on the side of the nose or other parts of the face or the legs.
Sometimes, sclerotherapy is also done to treat small external hemorrhoids on the anus. This is especially true for patients who cannot undergo a procedure like hemorrhoidectomy due to other health problems.
How do you prepare for sclerotherapy?
Consultation
Before scheduling you for a varicose vein procedure, your doctor will see you in office consultation. At this appointment, they will obtain a medical history and perform a physical exam. You should tell your doctor about all your health conditions, specifically any history of blood clots. Also tell them about any prior treatments for varicose veins.
Medications
Be sure to give your doctor a complete list of medications, including any over-the-counter herbal supplements. If you take blood thinners or non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, or naproxen, your doctor may instruct you to temporarily stop these medications for some time before your sclerotherapy procedure. Certain antibiotic medications like tetracycline or Minocin can stain the skin if taken within 7-10 days of sclerotherapy. Talk to your doctor about safely discontinuing these antibiotics before to your procedure. Steroid medications like prednisone can make the sclerosing solution less effective, so your doctor may ask you to discontinue it for around 48 hours before the procedure. It is advisable not to take iron supplements during sclerotherapy procedures because this can cause brown lines to appear in the skin. Also tell your doctor about any allergic reactions to medications.
Imaging Tests
Your doctor may order an imaging study with ultrasound. This is a painless procedure that uses sound waves to create images of internal structures. It will allow your doctor to look at the veins in your legs and plan out the injection sites.
Preparation
You should arrive for your sclerotherapy appointment without any lotion or other skincare products on your legs. Also, avoid shaving (you will have to avoid this until the injected veins have healed). Wear loose, comfortable clothing, preferably something like shorts or a dress in which your leg are exposed. If you have compression hosiery, please bring it to your sclerotherapy appointment.
What can I expect during varicose veins treatment?
Sclerotherapy is usually done in a doctor's office by a dermatologist or vascular surgeon. It does not require anesthesia. The entire process takes around 1 hour to complete. You will lie on comfortably on your back for the procedure with your legs slightly elevated. The doctor will clean the skin with alcohol. They will then inject the sclerosing agent slowly with a very fine needle at predetermined injection sites. Some sclerotherapy solutions contain lidocaine (local anesthetic) to reduce the discomfort in the veins injected. A foam is sometimes injected for large varicose veins because it covers more area than liquid.
After withdrawing the needle, the doctor will massage the area and apply compression. This helps to spread the solution evenly and keeps blood from flowing into the injected vessel. If you are having more than one varicose vein treated, the doctor may apply a compression pad on a treated vein before moving on to the next one.
How bad does sclerotherapy hurt?
Sclerotherapy is a minimally invasive procedure. Most people experience mild discomfort and minor stinging when varicose veins are injected. There can be a mild cramping sensation for a minute or two when larger veins are treated. Tell your doctor if you have a lot of pain. This can sometimes indicate that the solution is leaking from the vein into the surrounding tissue.
What happens after sclerotherapy?
Your doctor will provide medical advice. In general, you can get up, walk around, and go home soon after the sclerotherapy treatment. In fact, walking is encouraged to prevent clot formation. Your doctor will advise you to wear support hosiery or wear compression stockings for about 2 weeks. You may need someone to drive you home. Most people can resume normal activities the same day. You will, however, need to avoid strenuous activities for 2 weeks after sclerotherapy. Also, avoid sun exposure on the treated area because this can lead to dark spots in the skin, especially in people with a dark skin tone. You will also need to avoid hot tubs, saunas, hot compresses, and hot baths for a few of days after your sclerotherapy treatments.
What are the side effects of sclerotherapy?
It is not uncommon to have some temporary side effects at the injection site, such as bruising, redness, tiny skin sores, and discoloration or darkening of the skin. These injection site reactions usually disappear in a few days to weeks, but some can linger for longer. More serious side effects in the treated vessels that may require additional treatment include:
Inflammation
Swelling, warmth, and discomfort around the injected veins are usually mild. Your doctor may recommend over-the-counter anti-inflammatory drugs, if needed.
Blood Clots
A clot can form at the injection site, requiring drainage. Very rarely, a clot can travel into the leg veins and cause deep vein thrombosis. This is a potentially life-threatening condition if the clot travels to the lungs (this is known as pulmonary embolism). You should seek immediate medical care if you have symptoms like chest pain, difficulty breathing, or coughing up blood.
Air Bubbles
Tiny air bubbles can form in the blood stream. These may not cause any symptoms. However, sometimes they may cause fainting, headaches, visual disturbances, or nausea. Call your doctor if you have any unusual problems with sensation or limb movement after sclerotherapy.
Allergic Reactions
Rarely, there can be an allergic reaction to the sclerosing solution.
How long does sclerotherapy last?
Generally speaking, spider veins and small varicose veins respond in three to six weeks. Larger veins respond in three to four months on average. Remember that you may need multiple sclerotherapy treatments to achieve the desired results. Your doctor will advise you to wait around 6 weeks between sessions. A collapsed vein that has responded to sclerotherapy will not come back. However, new veins can appear.
What is the cost of sclerotherapy?
On average, sclerotherapy costs around $350 per session.
Is sclerotherapy covered by insurance?
If you are having sclerotherapy done for cosmetic reasons, it will not be covered by insurance. However, if your varicose veins are causing symptoms like pain and chronic swelling, you may have insurance coverage for sclerotherapy.
Finding a provider for sclerotherapy
The MeTime app makes it easy to connect with experienced dermatologists and vascular surgeons in your area. You can chat with experts, share photos, and get quotes. You can also find out about other sclerotherapy procedures like laser therapy. Download the MeTime app today and find out if you qualify for sclerotherapy of varicose veins.
