Sclerotherapy is a medical procedure used to treat varicose veins and “spider veins.” Sclerotherapy involves an injection of a solution (generally Sotradecol) directly into the vein. The solution irritates the lining of the vessel, causing it to swell, stick together, and disappear with time. Over time, the vessel turns into scar tissue that fades from view. Sclerotherapy is a well-proven procedure and has been in use since the 1930s. Sclerotherapy is performed in a doctor’s office. In most cases, the Sotradecol is injected with a very fine needle directly into the blood vessel. The number of veins injected in one session is variable, depending on the size and location of the veins, and the patient’s overall medical condition. Mild discomfort may occur, and a cramping sensation may be felt for 1 to 2 minutes when larger veins are injected. The procedure itself takes about 15 to 45 minutes. While usually quite effective, most insurance companies will not cover the cost of sclerotherapy. It is likely that direct patient charges will be necessary to cover professional time, supplies, sterile equipment, and drug costs etc.
How successful is sclerotherapy in treating varicose and spider veins?
Sclerotherapy works well for most patients. It is estimated that as many as 50 percent to 80 percent of injected veins may be eliminated with each injection session. A few (less than 10 percent) of the people who have sclerotherapy on their varicose veins do not respond to the injections at all. In these instances, a different method, such as laser therapy or ambulatory phlebectomy, may be tried.
In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months. If the veins respond to the treatment, they will not reappear. However, new veins may appear over time. If needed, you may return for further injections.
What you need to do before the procedure?
Prior to sclerotherapy, certain medications should be avoided. Tetracycline or Minocin, both antibiotics, may possibly cause a staining of the skin if taken 7 to 10 days before or after sclerotherapy. Ask your doctor about other antibiotic medications you may take, or ask for safe guidelines for discontinuing these medications. If you are required to take an antibiotic before any invasive procedure, such as dental procedures, colonoscopy or surgery, please inform your physician.
Do not take aspirin, ibuprofen (i.e. Advil and Nuprin) or other antiinflammatory medications for 48 hours before and after sclerotherapy, because these medications may interfere with the action of the sclerosing agent. Tylenol is permitted. Ask your doctor for specific guidelines before discontinuing any medication.
Prednisone also decreases the effectiveness of the sclerosing agent. Ask the doctor who prescribed your prednisone if it can be safely discontinued for 48 hours before the sclerotherapy procedure.
No lotion should be applied to the legs before or after sclerotherapy. It is recommended that you bring a pair of shorts to wear during the procedure.
If you have compression hosiery from previous treatments, please bring them with you so we can make sure they will provide adequate support after the procedure.
What are the side effects of sclerotherapy?
Certain side effects may be experienced after sclerotherapy. Larger injected varicose veins may become lumpy and hard for several months before resolving. Raised red areas may appear at the injection sites and should disappear within a few days. Brown lines or spots on the skin may be noted at the site of the injection, possibly caused by a form of iron that escapes from the injected veins. In most cases, they disappear within 3 to 6 months, but can be permanent about 5 percent of the time. Bruising may occur around the injection site and can last several days or weeks.
Other side effects rarely develop after sclerotherapy. If you have any of these side effects, please contact your physician immediately: - Inflammation within five inches of the groin
- Sudden onset of a swollen leg
- Formation of small ulcers at the injection site. This potential risk will be discussed by your physician proceeding any sclerotherapy procedures.
- Red streaking, especially in the groin area
- Allergic reactions to the sclerosing agent may occur at the time of the injection and are rarely serious.
Call your physician with any concerns or questions you may have after the procedure.
What happens after the treatment?
After the treatment you will be able to drive yourself home. You may resume your regular activities and are encouraged to walk. You will be instructed to wear support hosiery or compression wraps to “compress” the treated vessels. All support items can be purchased at your local pharmacy. Support stockings purchased from a department store may not be adequate if a heavy compression stocking is prescribed.
After the procedure, avoid aspirin, ibuprofen and other anti-inflammatory medications for at least 48 hours. Tylenol may be used if needed.
Do not take hot baths or sit in a whirlpool or sauna, nor apply hot compresses or any form of heat to the injected areas for 48 hours after treatment. In addition, avoid direct exposure to sunlight (sun bathing and tanning beds)jogging, high-impact aerobics and swimming for 7 to 10 days after the procedure.
Showers are permitted, but the water should be cooler than usual. The injection sites may be washed with a mild soap and lukewarm water.
How will I know if I am a candidate for sclerotherapy?
Prior to the procedure, you will have an initial consultation with a vascular surgeon who will tell you if you are eligible for sclerotherapy. You are not eligible for sclerotherapy if you are pregnant, breastfeeding, or are bedridden. You must wait at least three months after birth before you can be considered for this procedure. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be decided on an individual basis, and will depend on the extremity and the reason for the clot.
Veins that are potentially usable for future surgical bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery) will generally not be considered for injection, unless they are already deemed unusable for bypass procedures.
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