Sclerotherapy has been used in the treatment of spider veins and occasionally varicose veins for over 150 years. Like varicose vein surgery, sclerotherapy techniques have evolved during that time. Modern techniques including ultrasonographic guidance and foam sclerotherapy are the latest developments in this evolution.
Sclerotherapy is a popular method for eliminating spider veins that utilizes various solutions, called sclerosing agents, which are injected into the veins.
Sclerotherapy is one method, along with surgery, radiofrequency and laser ablation, for treatment of spider veins, occasionally varicose veins, and venous malformations.
Sclerotherapy under ultrasound guidance and using microfoam sclerosants has been shown to be effective in controlling reflux from the sapheno-femoral and sapheno-popliteal junctions.
Does Sclerotherapy work for everyone?
The majority of persons who have sclerotherapy performed note improvement in the appearance of the spider veins after 2 treatments.
Most patients require 6 treatments for complete clearing of the veins. Approximately 10% of patients who undergo sclerotherapy will have veins that do not totally disappear after six treatments. In very rare instances the patient’s condition may become worse after sclerotherapy treatment.
The best results will be obtained when the patient is conscientious about wearing the suggested support hose for three days following the injections. How many treatments will I need? The number of treatments needed to clear or improve the condition differs from patient to patient, depending on the size of the spider veins. One to six or more treatments may be needed; the average is three to four.
Individual veins usually require one to three treatments. Because only 3cc of sclerosing solution may be injected per visit, patients with many spider veins may only be able to have 30% – 50% of them treated each visit. The doctor will discuss this with you during your consultation appointment. Injections can be performed every 2 weeks. Each treatment takes approximately 30 minutes.
Sclerosants include the following:
- Detergents – Disrupt vein cellular membrane (protein theft denaturation):
- Sodium tetradecyl sulfate (Sotradecol)
- Polidocanol (Asclera, Aethoxysclerol)
- Sodium morrhuate (Scleromate)
- Ethanolamine Oleate (Ethamolin)
- Osmotic agents – Damage the cell by shifting the water balance through cellular gradient (osmotic) dehydration and cell membrane denaturation:
- Hypertonic sodium chloride solution
- Sodium chloride solution with dextrose (Sclerodex)
- Chemical irritants – Damage the cell wall by direct caustic destruction of endothelium
- Chromated glycerin (Sclermo)
- Polyiodinated iodine
The lead principle in sclerotherapy is to cause irreversible endothelial injury in the desired vessels while avoiding damage to normal collateral vessels and surrounding tissues. The lowest effective volume and concentration of the most suitable sclerosant should be used to minimize the likelihood of adverse effects. Factors such as sclerosant concentration, volume, mixing, and procedure technique are more important factors than the choice of the sclerosant itself.