Are You a Candidate?
All new patients undergo a lower extremity venous ultrasound to rule out underlying venous reflux (valve failure) 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 the gold standard for the treatment for spider veins. Most patients who have spider veins alone (without associated varicose veins) do not have underlying venous reflux and can be simply treated with sclerotherapy alone. But, an ultrasound exam is the only way to know for certain.
How Does Sclerotherapy Work?
Sclerotherapy works by causing an inflammatory reaction in the spider vein that eventually leads to fibrosis and closure of the vein. Do not be surprised when the injected veins actually look worse during the first few days after the sclerotherapy session. This is a result of the inflammatory reaction and is to be expected. You may also notice small areas of clot (dark blood) within the injected veins. This is not the type of blood clot that can be life threatening and it should resolve on its own with time. Should the clotted vein cause any discomfort, we will make a small pin prick in the skin overlying the clot and express it from the vein. The discomfort should then quickly resolve.
Some spider veins are more resistant to sclerosis than others. We will adjust the concentration (power) of the sclerotherapy agents depending on the success of the previous sclerotherapy session.
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, 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. We have Arnica for purchase in the clinic which will help limit the amount of bruising.
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 spaced 1 month apart to get optimum results. 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 sclerotherapy session to keep their legs in top shape.
Patients are fitted with thigh high compression hose that they wear for 5 days following the sclerothrapy session. We have the hose for purchase in our clinic or you may bring your own if you have them. Just make sure that they are thigh high grade 2 compression hose. Compression hose are an essential component of successful sclerotherapy. They dramatically increase the number of spider veins that can be cleared with each sclerotherapy session. They do this by compressing the walls of the spider veins together which allows the sclerotherapy to be more effective. 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 very rare and are greatly diminished by your being compliant with wearing the compression hose. We have successfully performed many thousands of sclerotherapy injections and know how to manage any complications should they arise.
1. insurance does not cover sclerotherapy for spider veins – we charge $450 for a sclerotherapy session which involves injecting both legs, front and back.
2. more than one sclerotherapy session will be needed to achieve maximum spider vein clearance
3. the result of each sclerotherapy session builds on the success of the session that preceded it
4. maintenance sclerotherapy sessions will be required through the years to keep your legs in top shape
5. thigh high compression hose are worn for 5 days following a sclerotherapy session
Mississippi Vein Institute Sclerotherapy Policy
1. Sclerotherapy for spider veins is not covered by insurance. Our charge is $450 per session. Each session includes injecting both legs, front and back.
2. You will need more than 1 sclerotherapy session to attain 90% clearance of your original spider vein burden. Each session should eliminate 60% of the existing spider vein burden. Sclerotherapy sessions are generally spaced 6 weeks apart. There is no way to predict exactly how many sessions will be needed. We simply have to perform your first session, see how you respond, and make our plans from there.
3. Sclerotherapy works by causing an inflammatory reaction within the spider veins that leads to fibrosis and eventual destruction of the spider veins. Your legs will look worse before they look better. There will be some bruising and some degree of mild skin irritation that lasts a few days following the session. You will wear thigh high grade 2 compression hose for 5 days following a sclerotherapy session. The compression hose dramatically improve the destruction of the spider veins following a sclerotherapy session. No hot baths for 5 days following a session otherwise, there is no restriction in your activity. We have high quality compression hose for purchase in the clinic or you may bring your own.
4. You will be seen 1 to 2 weeks following your initial sclerotherapy session for a follow-up appointment to assess your response to the sclerotherapy injections. Plans for any additional sclerotherapy sessions will be made at that visit.
5. Most sclerotherapy sessions last 30 to 40 minutes. The pain involved is minimal and is well tolerated by the vast majority of patients. Sedation is available for a $50 charge but most patients do not require it. If sedation is requested, you will need a driver. Otherwise, you may drive yourself.
6. We have Arnica for purchase ($25) in the clinic which will help limit any associated bruising.
Michael Manning, MD Cliff Adams, MD