Sclerotherapy safe and effective for small veins.
Although standard sclerotherapy has been performed since the 1930’s for surface veins
"Sclerotherapy" is the procedure used to treat abnormal veins. It involves the injection of a solution into the abnormal vein with a very fine needle. Sclerotherapy has been used for spider veins since the 1930’s. The solutions are specifically manufactured for sclerotherapy. Both are rapidly broken down after contact with the vein wall and so do not circulate through the body as an active solution. The solution irritates the lining of the vessel causing it to swell and stick together. Over a period of weeks the vessel fades from view usually completely.
Sclerotherapy can be used for surface veins by direct injection or for deeper veins by injecting under ultrasound guidance
Depending on its size, a single blood vessel may have to be injected more than once. In each treatment session many vessels are injected but it involves minimal discomfort because of the tiny diameter of the needles. Some injections give a feeling like a bull-ant bite. Because larger veins (reticular veins) are often associated with spider veins these vessels must be treated first and the smaller "spider" veins are then usually treated 4 weeks later. Following treatment sessions you will be required to wear a special venous compression stocking to assist in sealing off the abnormal veins. The length of time that the stocking will be required to be worn varies from 3 - 5 days. Compression minimises the formation of haematoma (blood clot) and pigmentation, reduces the number of treatments necessary, reduces the risk of deep venous thrombosis and reduces the possibility of recurrence.
How successful is the treatment?
After several treatments most patients can usually expect at least an 85 percent improvement in the appearance of their legs. If you have had previous sclerotherapy treatment elsewhere or surgery then your results will not be as good as if you have not been treated before. You initially look worse because of bruising. The improvement may be very gradual with some vessels taking up to 3 months to show maximum benefit. Sometimes there is little noticeable improvement after the first treatment session of the larger reticular veins. Sometimes treated vessels (particularly telangiectasias) may be more noticeable after treatment because of a small amount of trapped blood. This blood will gradually dissolve.
Veins that have been adequately treated by sclerotherapy will not recur. However, the underlying weakness in other veins is not affected and therefore new vessels may appear with time. To minimise the development of new abnormal veins it is important to maintain normal body weight, exercise regularly, avoid constipation and minimise the wearing of high-heeled shoes. If your condition is severe then it may be appropriate to wear support stockings each day. These stockings are not as "heavy" as the stockings used after treatments but offer more support than normal stockings. These can be purchased from this clinic. A yearly "check-up" may be recommended to detect the development of new veins, which can then be treated easily.
Possible side effects
One of the most unlikely, but sinister problems, is deep vein thrombosis (DVT). This can occur but is uncommon if compression and regular daily walking are adhered to. There is some suggestion that the taking of the oral contraceptive pill and hormone replacement therapy (for menopause symptoms) during treatment increases the risk of a DVT, however the evidence is weak and is probably not a reason to stop taking these medications during treatment. Similarly, people who smoke have a slight increase in risk.
More common side effects are:
Bruises at injected site. These will usually disappear within a few weeks. Blood trapped in the sclerosed vein may cause the vein to become more noticeable in the first few weeks following treatment, and is an early sign that the treatment has been successful.
Aching in the leg for the first day or two following treatment. This is unlikely unless you have varicose veins treated or have a particularly large treatment session. This aching is usually relieved by walking. Panadol is rarely necessary.
Phlebitis: This is an inflammation of the treated blood vessels, which may also be associated with tender lumps along the line of the treated veins. This is unlikely unless you have varicose veins treated. It is due to the reaction of the sclerosant on the blood vessel wall and the trapping of "old" blood. When it occurs to a large or prolonged extent it may be treated by draining the blood out of the painful lumps by a small needle puncture. Other treatments for this may include anti-inflammatory medication, heat packs, massage with a special cream, compression and regular walking. The lumps will always disappear with time, but this may take several months.
Pigmentation: This is the appearance of brown marks on the skin after treatment along the line of a treated vein. Some studies show an incidence as high as 16% at 6 months and 5% at 2 years. These pigmented areas are mainly composed of haemosiderin (a form of iron stored in the blood) and are the result of the blood being broken down in a vein after treatment. It is more likely to occur in patients who have larger veins treated or those patients who have a lot of bruising. In most cases pigmentation disappears completely within a year. Persistent pigmentation may respond to laser treatment.
Matting: This is the development of networks of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs. Most resolve spontaneously, some resolve with injection treatment, and a few persist. Matting is more common in patients with extensive surface veins, deep vein problems, patients who have a family history of surface veins, obese patients who have poor muscle tone and those patients who have not had reticular veins treated before spider veins.
Ulcers: Very occasionally there is the formation of small, painful ulcers at a treatment site within 2 weeks of injection. These may occur because the solution has escaped into the surrounding skin or sometimes because there is an abnormal connection between the small veins that are injected and the nearby arteries. Ulcers are more common in patients who smoke cigarettes. They heal slowly and may leave a small pale scar.
Allergic reactions: Although on rare occasions (1 per 5,000) such reactions may be serious, they can usually be very effectively treated by the immediate injection of adrenaline. Less serious reactions are treated with antihistamines. Minor rashes require no specific treatment but you should inform the doctor if they occur. Rarely, inflammation of the gums (gingivitis) appears as a reaction to a specific sclerosing solution. If this occurs, a different solution can be used for subsequent treatments.
Intra-arterial injection. This is an extremely uncommon complication, which may result in muscle and skin damage.
SCLEROTHERAPY
