Sclerotherapy is a medical procedure used to treat varicose veins and "spider veins". Sclerotherapy involves an injection of a solution (generally sodium chloride) directly into the varicose vein. The solution irritates the lining of the vessel, causing it to swell and stick together, and the blood to clot. Over time, the vessel turns into scar tissue that fades from view. Sclerotherapy is a well-proven procedure has been in use since the 1930s to treat varicose veins.
Q. How is sclerotherapy done ?
Sclerotherapy is performed in a doctor's office. In most cases, a 23 percent sodium chloride sterile solution mixed with lidocaine (a local anesthetic) and heparin is injected into a very fine needle directly into the blood vessel, using a very fine needle. A solution without lidocaine is available for people who are allergic to lidocaine. The number of varicose 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 varicose veins are injected. The sclerotherapy procedure itself takes about 30 to 45 minutes.
Q. How successful is sclerotherapy in treating varicose and spider veins ?
Sclerotherapy works well for most patients with varicose veins. It is estimated that as many as 50 percent to 80 percent of injected varicose 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, different solutions or a different method, such as laser therapy, may be tried.
In general, spider veins respond to sclerotherapy 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 injections.
Q. 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 anti-inflammatory 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 prior to sclerotherapy.
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 is to be applied to the legs before or after sclerotherapy. It is recommended that you bring a pair of shorts to wear during the varicose vein treatment 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 sclerotherapy procedure.
Q. 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
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 sclerotherapy procedure.
Q. 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 The Cleveland Clinic. 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.
Q. How will I know if I am a candidate for sclerotherapy ?
Prior to the procedure, you will have an initial consultation with a vascular medicine specialist who will tell you if you are eligible for sclerotherapy. You are not eligible for sclerotherapy if you are pregnant, breast feeding, 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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