Sclerotherapy

Are You a Candidate?

All new patients undergo a lower extremity venous ultrasound to rule out underlying venous reflux as a potential cause of their vein related complaints. Sclerotherapy for spider veins in the setting of significant underlying venous reflux will not be effective. The sclerotherapy results will not last until the underlying venous reflux is addressed. Sclerotherapy is an excellent treatment for spider veins in the absence of underlying venous reflux.

BEFORE	AFTER 2 MONTHS

What Does the Procedure Involve?

The areas of concern are photographed. The sclerotherapy injections are done using a very small 30 guage needle. Most patients tolerate the injections fine but, for those who don't, intravenous sedation is available. A driver is necessary if sedation is used. The area to be injected is cleaned thoroughly with alcohol. We use a piece of equipment called a Vein Light to guide our injections. The Vein Light allows us to see the larger reticular veins which are often feeding the spider vein clusters. Injections placed directly into these "feeder" veins, when present, are essential to effectively treat spider veins at the skin surface.

We use a combination of tetradecyl sulfate and glycerin as our primary sclerotherapy agent. The combination of the two agents is quite effective and results in much less pain upon injection when compared to other sclerotherapy agents. It is not unusual to experience a red whelp at the injection sites, much like a fire ant bite. The whelp usually lasts for a few hours and is not something to worry about. Bruising is also a common occurence following a sclerotherapy session. The bruising typically clears in one to two weeks.

The question most commonly asked is "How many sclerotherapy sessions will i need". The answer depends on the severity of the spider veins. We are usually able to clear 60% of an existing spider vein burden with each treatment. Most patients undergo 2 to 3 sclerotherapy sessions 6 weeks apart to get the results they want. The thing to realize is that each sclerotherapy session builds on the results of the previous session. The spider veins that we successfully eliminate will not recur but more spider veins may show up in a different area as the years go by. Most patients stop by every year or two for a maintenance session to maintain their results.

Patients are fitted with compression hose that they wear for 5 days following the sclerothrapy session. Compression hose are an essential component of successful sclerotherapy. The hose may be removed to shower and sleep. Hot baths  are discouraged for the first week after sclerotherapy injections. Soaking in a hot bath dilates the veins and makes it harder for the sclerosing agent to close the spider veins. Otherwise, resumption of normal activity is encouraged immediately following sclerotherapy.

Are There Any Potential Complications?

The potential complications of sclerotherapy include skin ulceration, infection, hyperpigmentation of the skin, formation of small superficial blood clots, and formation of deep venous blood clots. Complications following properly performed sclerotherapy are generally rare and are greatly diminished by being compliant with wearing the compression hose. African-Americans and others with dark skin tones are best treated with glycerin alone as the sclerosing agent. This is done to further decrease the chance of skin hyperpigmentation following sclerotherapy. It is not uncommon to require up to 6 weeks to fully manifest. Therefore, subsequent sclerotherapy sessions are scheduled at 6 week intervals.

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