Sclerotherapy

Some of the reasons for performing sclerotherapy are mentioned below:

• Mostly sclerotherapy is performed for cosmetic purposes i.e. to enhance the bad appearance of spider veins and varicose veins
• The sclerotherapy can also improve some associated symptoms like:
  • Swelling
  • Severe pain
  • Burning
  • Cramps at night
  • Feeling of heaviness
• Sometimes, too much pressure in the varicose veins may result in skin sores or changes in the skin. In such cases, sclerotherapy is required.

If the patient is pregnant, bedridden and breastfeeding, then the doctor advises waiting for some time before the sclerotherapy procedure is done. In the case of pregnancy, the patient should wait until 3 months post-delivery. Sclerotherapy procedure can be performed even if a patient is taking birth controlling pills.

Sclerotherapy is a safe procedure with minimal complications. Some of the complications, which can be experienced by the patient are as mentioned below:

• Temporary complications: These usually occur at the injection site.
  • Swelling at the injection site and sometimes, within the area of 5 inches of the groin.
  • Redness
  • Small skin sore
  • Skin changes like dark skin in the form of spots or lines.
  • Bruising
  • Numerous visible spots like red blood vessels may appear on the treated area, also known as revascularization. Eventually, however, these spots disappear in a few weeks and do not require any treatment.
  • Swollen leg
  • Ulcer formation

The above-mentioned complications are temporary and usually, would go away in some days or few weeks.

• Serious complications – The chance of having any serious complication is rare but if these occur, then some treatment would be required. Some of the complications, which can occur, are mentioned below.
  • Clotting of blood – If there is any blood clot formed in the treated veins, then drainage may be required. In rare cases, this blood clot may lead to deep vein thrombosis i.e. blood clot traveling to a deeper vein in the leg. In such cases, this clot may travel further from the legs to the lungs, obstructing the vital artery. This condition is known as pulmonary embolism and may create an emergency. The symptoms of pulmonary embolism are coughing up blood, chest pain, breathlessness or dizziness. In such cases, it is very important to call a doctor, immediately.
  • Inflammation – Sometimes a patient may experience pain, discomfort, redness and swelling at the site of injection. The doctor might advise taking some antibiotics or painkillers.
  • Allergic reactions – In rare cases, people may develop allergic reactions from the solution used for performing sclerotherapy.
  • Air bubbles – Sometimes, air bubbles are formed in the bloodstream but they usually go away and do not create any issues. In some people, these bubbles might cause a slight headache, visual problems, nausea, and coughing. If these symptoms are observed, the patient must inform the doctor immediately.
  • Lumpy veins – Sometimes, the larger veins may become lumpy after the sclerotherapy solution is injected into them. This condition of lumpy veins may take many months to dissolve and disappear.
  • Nerve damage
  • Leakage in the treated veins which may cause severe pain and irritation.

The doctor will discuss the sclerotherapy procedure in detail with the patient. Before going for the procedure, the doctor may look for the following details from the patient:

• Medical history – The doctor would typically ask for the complete medical history of the patient which includes the following:
• Any allergies
• Past illnesses or medical problems (in the past or present) e.g. heart diseases, lung or kidney problems.
• Information about all the supplements or medicines a patient is taking such as blood thinning medications (aspirin), antibiotics or NSAIDS (Non-steroidal anti-inflammatory drugs). If a patient is taking these medicines then the doctor might advise to stop these for some time, before or after the procedure.
• If undergone any varicose veins treatment, previously and about its results.
• If the patient is a smoker or takes oral contraceptives, which may increase the chances of blood clots.
• Physical examination – The doctor examines the patient carefully for any underlying disease of blood vessels and then assesses the affected veins.
• One day prior to the sclerotherapy, the patient is advised to avoid applying any lotions or creams on the affected area and also avoid waxing or shaving
• The patient is asked to prefer wearing comfortable or loose clothes for the procedure

During the procedure:

The procedure of sclerotherapy does not require any anesthesia and is usually performed in the outpatient area. The procedure does not need any hospitalization for the patient. The procedure takes less than 1 hour to complete.

During the procedure, the patient is asked to lie on the back with legs slightly raised. The affected area is then cleansed with alcohol. The doctor slowly puts a very fine needle with a solution, into the affected veins. The solution used in sclerotherapy is liquid in nature and causes a sensation of irritation in the veins which lead to swelling and blocking of the blood flow in the area. This further causes scarring and collapsing of the veins, which then pushes the blood into the healthy veins. The affected veins collapse and get absorbed by the surrounding tissue, and slowly fade away. If the affected area is bigger, then the doctors prefer to use a foam solution as it covers more area than a liquid.

In some cases, patients might feel a cramp or a stinging sensation while injecting the solution. If the pain gets severe and uncontrollable, the patient is advised to inform the doctor immediately as the solution might have leaked into the surrounding tissues. Once the needle is removed, the doctor massages and compresses the area softly so that the solution can disperse. The doctor may attach a compression pad on the treated area to keep it compressed so the doctor can move onto the next affected vein. The number of injections, depend upon the size and the number of the veins being treated.

After the procedure:

After the sclerotherapy is done, the patient is advised to rest in the same position for at least 15 to 20 minutes. The doctor will examine the treated areas carefully for any immediate complications. The patient is then allowed to stand up and take a walk. Moving the legs is necessary as it will prevent any clot formation.

The doctor advises the patients to continue wearing the compression pads or stockings for at least 3 weeks, in order to provide constant compression to the treated area. The patient is advised to get a companion along to take care of the patient after the sclerotherapy and drive back home.

The patient is allowed to go back home, the same day of the procedure and return to normal routine activities. The patient is asked to avoid doing any strenuous exercises or physical activities.  The patient is also asked to avoid direct sun exposure as the sun exposure on the injection site may cause inflammation and dark spots on the treated area.

If the spider veins and varicose veins treated are in a small area then the patients can see the results in 3 to 6 weeks. However, if the veins treated are bigger and in a larger area, then it may take 3 to 4 months to get the desired results.

Sometimes, the larger veins may become lumpy after injecting the sclerotherapy solution into them. This condition of lumpy veins may take many months to dissolve and disappear.

There is no chance of recurrence of the condition in the treated veins, but some new veins may develop. A follow-up will be advised after a month to examine the progress of the treatment and decide if any more sclerotherapy sessions are required.

The success rate of sclerotherapy in treating and completely eliminating the spider veins and varicose veins is around 50 to 80%. However, some things, which need to be avoided after the sclerotherapy are as mentioned:

• Hot compressions to the areas treated
• Hot baths
• Sauna
• Long airplane flights
• Direct sun exposure

Q1. What are the areas which can be treated with sclerotherapy?

A1. According to the size of the veins damaged, the procedure of sclerotherapy can be performed to treat the spider veins and varicose veins in the below mentioned areas:

• Feet
• Ankles
• Thighs
• Calves
• Anus
• Face, usually the sides of the nose.

Q2. What are the solutions used, during sclerotherapy, to treat varicose veins?

A2. Multiple solutions can be used during sclerotherapy, to treat spider veins and varicose veins. The solutions used are as mentioned below.

• Hypertonic saline solutions
• Sodium tetradecyl sulfate
• Polidocanol

Functions of sclerotherapy solutions:

• The solution used in sclerotherapy is liquid in nature and causes a sensation of irritation in the veins, which lead to swelling and then blocking of the blood flow in the area.
• This further causes scarring and collapsing of the veins, which then pushes the blood into the healthy veins. The affected veins collapse and get absorbed by the surrounding tissue, and slowly fade away.
• If the affected area is bigger, then the doctors prefer to use a foam solution as it covers more area easily than a liquid.