Sclerotherapy for Treating Varicose Veins

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What is Sclerotherapy?

Sclerotherapy is a minimally invasive treatment option for spider and varicose veins. Sclerotherapy involves injecting an irritant medication (called “sclerosant”) into the abnormal veins. This causes the vein to seal and eventually be absorbed by the body.

How is Sclerotherapy performed?

Sclerotherapy treatment sessions are performed at Sunshine Coast Vascular, and are “walk in, walk out” and usually last 30-60 mins.

Different techniques for administering the sclerosant are used depending on the size and location of the vein.  Veins that are very close to the skin are accessed directly with a very fine needle.  Deeper varicose veins are precisely targeted using ultrasound guidance.  Multiple injections are often needed along the length of longer varicose veins.

Often the sclerosant is mixed with gas to form a very fine foam.  This improves the effectiveness of the treatment, and also enables the sclerosant to be visualised on ultrasound so it’s delivery can be more precisely controlled.

At the completion of treatment a compression stocking is applied to the leg.  This is a very important part of the treatment, and is usually worn for 1-2 weeks depending on the size of the veins injected.  After going for a half an hour walk, you can return to normal day to day activites.

You can drive to and from the treatment, and return to work if needed.

Woman rubs varicose vein on leg after taking off shoes

Is Sclerotherapy painful?

The procedure involves passing a very fine needle through the skin into the abnormal vein, so there is some discomfort, although most people tolerate the procedure very well.  Some even fall asleep!  The needles used are tiny – much smaller than the needles used for a blood test.  No anaesthetic is required.

Sometimes there is some discomfort in the treated vein for a few weeks after the procedure.  This is much more common if the treated vein is very large.

How many Sclerotherapy treatments are required?

A large number of veins can potentially be treated in the one session, although there is a maximum dose of sclerosant that can safely be injected at the one time. The effectiveness of treatment also varies from individual to individual, and according to the size of the veins treated.  On average, about 80% of veins are successfully treated with each treatment.

Several sessions can therefore potentially be required depending on the extent of the problem, the desired results and the individual response to treatment. Overall >90% of patients have a substantial improvement at the end of the recommended treatment course.

Are there any possible side effects to Sclerotherapy?

Like all invasive procedures there are risks of side effects, although serious complications are rare.  The risks, benefits and alternatives should always be considered and discussed with your medical practitioner before undertaking any treatment.

Potential side effects include:

  • bruising
  • phlebitis – the treated veins may temporarily become firm, tender and lumpy, particularly larger veins.  This is very common and part of the healing process.  The tenderness usually improves quickly, often in days, while the lumpiness can sometimes take weeks or months to disappear completely.  Sometimes “trapped blood” within treated veins can need to be removed with a needle in the weeks after treatment to help this settle and reduce pigmentation.
  • pigmentation – successfully treated veins will often appear darker immediately after treatment, and they may even temporarily appear worse.  Again, this is part of the healing process.  In most people it fades after a few months, although in a very small fraction of people it may take 12 months or more to fully resolve.
  • matting – new tiny spider veins may occassionally appear adjacent to the treated area.  This occurs in up to 1 in 20 patients. This usually improves with time, although it may not completely resolve.  Occassionally a trigger can be identified and addressed, such as a persisting deeper feeding vein, although it tends to recur with repeated treatments.
  • allergic reactions – life threatening reactions are extremely rare.  Sclerotherapy should always be perfomed by an appropriately qualified medical practitioner equipped to deal with such an event.
  • skin blistering/ulcers – this can occur if the blood supply to the skin is effected or if the sclerosant is injected outside of the vein.  This occurs in less than one in a thousand cases, and may take a long time to heal or result in scarring.
  • deep vein thrombosis – this is extremely rare, but is one of the more serious potential complications of vein treatment.  Sunshine Coast Vascular patients are provided with a list of precautions to follow before and after treatment sessions to minimise the chances of this occuring.  This includes regular walking and avoiding long-haul flights close to treatments.  The use of compression stockings during treatment is very important to help minimise the risk of DVT.

Will the varicose veins come back?

Individuals who develop varicose and spider veins in the first place usually have a propensity to form them, and therefore often continue to form them into the future.  Over time veins that were healthy at the time of treatment may eventually become abnormal.  If this occurs, then further treatment can usually be performed.

Can Sclerotherapy be used on all varicose veins?

Sclerotherapy can be used on most varicose veins, although success rates vary with the size of the vein.  The best results are achieved with small-medium varicose veins and spider veins.  It can still be used on very large varicose veins, although the healing process is often longer and more unpleasant.  “Phlebectomies”, where the varicose vein is removed with a special hook through a tiny incision in the skin, is an alternative option for very large varicose veins.

Many patients with varicose veins actually have abnormal saphenous veins as the underlying cause.  These are long, straight veins that sit deep in the fat layer on the inside and back of the leg.  These particular veins can also technically be treated with sclerotherapy, although the success and complication rates aren’t anywhere near as good as other available options, such as Venaseal “glue” or Endovenous thermal ablation (laser/radiofrequency).  Sclerotherapy is therefore not usually a first line treatment for abnormal saphenous veins.  Many patients, particularly those with more extensive problems, therefore require a combination of treatment different methods to achieve the best results.

Is Sclerotherapy an option for me?

In order to determine what options may be appropriate for you, you will need a referral from your General Practitioner to arrange a consultation with Dr Magee at Sunshine Coast Vascular. Dr Rebecca Magee is an experienced vascular and endovascular surgeon on the Sunshine Coast, offering a full suite of treatment options for varicose veins. Dr Magee offers both “walk in, walk out” and day surgery treatment options. Contact us to request an appointment.

Have a referral?

Book your Sclerotherapy consultation today.

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