Sclerotherapy

During the sclerotherapy procedure, your doctor injects a chemical into your vein to obliterate it.

• During the sclerotherapy procedure, a health care professional injects chemicals into smaller veins, which damage the inner lining and produce a clot. As the clot is reabsorbed, the vessel is permanently obliterated.
• The choice of the chemical sclerosing agent and its physical form depend on the size of the vessel to be treated.
• Treatment of the correct vessels can improve the symptoms of venous insufficiency.
• Small superficial vessels are often destroyed for cosmetic reasons.

Sclerotherapy is a medical procedure whereby a chemical, the sclerosant, is injected into a vein to entirely obliterate it. The sclerosant damages the innermost lining of the vessel (the endothelium), resulting in a clot that blocks the blood circulation in the vein beyond. Veins carry unoxygenated blood from the peripheral tissues back to the heart. Since the venous blood pressure in the veins is low, the blood is pumped by forward by contractions of the heart. To prevent back-flow, most veins have valves that only allow blood only to flow in the direction of the heart. When these valves become incompetent, veins become enlarged and bulging (varicose). Smaller veins that feed these varicose veins can also become enlarged and appear as red or blue spider veins in the skin. Varicose veins can lead to a chronic swelling condition of the leg called venous insufficiency. Venous insufficiency predisposes a person to leg swelling, blood clots, and skin ulceration. Even more frequently, damaged veins are manifested as unsightly spider veins. The destruction of these types of veins can be desirable both medically and cosmetically.

All medical procedures have risks that should be considered carefully prior to embarking on a particular treatment. Since sclerotherapy is frequently used to treat cosmetic problems, untoward and dangerous side effects ought to be fully explained to the patient.

Because this procedure requires injections through the skin, it is not a painless procedure. Some chemicals that are injected (sclerosants) are more likely to cause pain than others. If the sclerosant is deposited outside the vein inadvertently, this is often more painful.

Sclerotherapy is an effective technique to obliterate or collapse veins. Other techniques include surgical removal of the offending vein, endovenous laser destruction (fiberoptic-transmitted laser light) and, for very small vessels, percutaneous laser light or intense pulsed-light exposure are also effective.

Those with venous insufficiency who have disease that is poorly controlled with compression stockings and who are not obese are ideal candidates for sclerotherapy. To determine if sclerotherapy obliteration is likely to be of benefit, the site of the defective vein is identified as well as the venous drainage pattern. Healthy people who complain of unsightly superficial veins of small caliber (4 mm or less) are also candidates for sclerotherapy.

Patients are screened using special ultrasound techniques to determine the site of venous disease prior to treatment. In situations where there is only a small area of spider veins, this is rarely done.

There are now two FDA-approved sclerosants available, sodium tetradecyl sulfate (a detergent) and polidocanol (Asclera). For small veins, hypertonic saline is occasionally used. Depending on the size of the vein to be treated, the sclerosant may be administered as foam. A needle of the appropriate caliber is inserted into the vessel to be treated, and the chemical is injected.

This is an outpatient procedure and the patient leaves the office on the same day of treatment.

Patients should wear compression dressings for one to three weeks after treatment. A follow-up visit within two weeks to enable the evacuation of blood clots in larger veins can improve the prognosis and the appearance.

For patients with venous insufficiency, treatment can be beneficial by improving venous blood flow and limiting chronic swelling. For those with cosmetic complaints, their appearance can be improved.

Sclerotherapy risks, side effects, and complications include hyperpigmentation, temporary swelling, capillary dilation (telangiectatic matting), pain from the injection, localized hives, tape compression blister, tape compression folliculitis, and recurrence, vasovagal reflex, localized hair growth (hirsutism), skin death (cutaneous necrosis), allergic reaction, superficial thrombophlebitis, arterial injection, pulmonary embolism, deep vein thrombosis, nerve damage, and migraine headaches.

Although insurance companies differ in their coverage and preapproval is always helpful, the treatment of venous insufficiency is usually covered. The treatment of cosmetic problems including spider veins is rarely covered.