Sclerotherapy

Sclerotherapy is a procedure correcting small subcutaneous or intracutaneous varicose veins, during which a sclerosing substance (sclerosant) is injected into the vein with a fine needle.

Sclerosing substance

The sclerosant irritates the blood vessels causing so-called “sticking together” of veins. In most cases the vein constricts for a couple of weeks after the procedure until it is not visible any more. During each treatment session the veins are injected in different sites. As the needles are very fine, the procedure is usually accompanied with mild feeling of discomfort. Some injections may feel like ant or mosquito bite. It is not possible to predict before the procedure how many times the procedure should be performed to remove the varicose veins.

Results

It may happen that the varicose veins don’t react to sclerotherapy. Usually it possible to say after 1-3 procedures if the varicosis reacts to the used sclerosant or not. To evaluate this the varicosis should be photographed before each procedure.
Varicose veins treated with sclerotherapy will usually not recur. Despite this sclerotherapy doesn’t improve the general weakness of venous walls and therefore new varicose veins may develop with time in treated area as well as in other areas.

Other treatment options

There is no other option than sclerotherapy to correct certain type of varicose veins, also compression therapy has no results in correcting or controlling web-like varicosis.

Risks and complications

Possible risks and complications of sclerotherapy are bruising, ulcerations, deep vein thrombosis, allergic reaction to sclerosant, hyperpigmentation, development of fine web of vessels (so-called venous matting).
Bruising (haematomas) may develop after sclerotherapy at the injection site. These will disappear after some time. Leg pain may also occur during the first days after the procedure.

Change of skin colour (hyperpigmentation) may occur at the injection site of sclerosant. Usually the colour change disappears quickly but in 1% of the patients it is possible that the change of skin colour is permanent. As hyperpigmentation develops in sunlight, it is not recommended to sunbathe the regions treated with sclerotherapy for one month.

In patients with a history of migraine the use of foamed sclerosant can cause migraine exacerbation.
Very rarely small painful ulcers may develop in treated areas within two weeks after injection. This is caused by the penetration of the solution into surrounding skin, but sometimes also by abnormal connections occurring between arteries and veins. The ulcers are more common in smoking patients. The ulcers heal slowly and may leave small pale scars.

Allergic reaction to the sclerosant is a rare complication (1:5000) but it may have severe consequences that require immediate treatment. Mild rash doesn’t require special treatment, but if it occurs you should inform your doctor.

In the injection area or over the bigger blood vessels, especially on thighs, a web of fine red blood vessels may develop. Most of the vessels disappear for themselves and part of them recedes with injecting, but also more permanent form is present. The development of the web of blood vessels is more usual in patients, who have:
• extensive superficial veins,
• genetic tendency for the development of superficial varicose veins,
• overweight and weak muscle tone.

Inflammation of blood vessel wall (phlebitis) is a treated inflammation of blood vessel, during which painful bumps develop along the blood vessel. The inflammation is caused by the reaction of the sclerosing substance with blood vessel wall and retention of blood in the blood vessel. Compression, regular walking, application of special ointments and gels are helpful. The lumps disappear with time but it may take some months. Sometimes it is wise by the doctor to remove some of the collected thrombosis from the treated part of the vein to make the healing faster. That is one part of the follow-up visit.

Deep vein thrombosis is mainly caused by injection of stronger solution of sclerosant into the main vein of the superficial vein system.

Entering of the sclerosant into arteries is a very rare complication that can result in muscle and skin damage.

Post-procedure activities

Wearing support stockings should be started immediately after sclerotherapy: class II, average pressure 17-23 mmHg.

The stockings should be used for 2 weeks after the procedure: they should be worn for the whole first day and later only during daytime.

Everyday activities may be continued after sclerotherapy, only hot baths and sauna should be given up (during 1st month).

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