Here you will find detailed answers to your questions about sclerotherapy – a treatment commonly used to treat venous disease.
For a quick rundown on sclerotherapy with Dr Grace – check out this video:
- What does sclerotherapy involve?
- What types of sclerotherapy are there?
- Is sclerotherapy a painful procedure?
- What is trapped blood and how does it occur?
- Can sclerotherapy be unsafe?
- Will abnormal veins keep coming back?
- Can sclerotherapy be undergone if pregnant or breast-feeding?
- How long does the procedure take?
1. What does sclerotherapy involve?
Sclerotherapy involves the injection of a sclerosant into the diseased veins. A sclerosant is a drug that causes veins to shrink. When a sclerosant is injected into the diseased vessel, it effectively destroys the vein wall. The complete process usually takes approximately 2-3 months. The sclerosants most commonly used are sodium tetradecyl sulphate and aethoxyscerol.
Sclerotherapy has been used for spider veins since the 1930s and long before that for larger veins. Over the past 5-10 years the sclerotherapy technique has been vastly improved through the use of ultrasound technology and sclerosant foam. Foam is formed by mixing 1/10 to 1/20 of the usual volume of sclerosant solution with air. With a fraction of the sclerosant solution that was formerly required, the same outcome may be achieved with foam. The European Consensus Meeting on Foam Sclerotherapy (Germany, 4th-6th April, 2003) and the Australasian Consensus 2004 have fully endorsed the use of foam.
The stages of sclerotherapy over time.
Due to limits in the volumes and concentration of sclerosant that can safely be used in any single treatment session, only one leg is treated at a time. The same leg may be retreated as early as 2 weeks after initial treatment but, as prevously mentioned, optimal retreatment intervals are approximately 9-12 weeks. This ensures a minimal number of treatment sessions, improves results, and helps reduce costs. The other leg may be treated the week following initial treatment.
2. What types of sclerotherapy are there?
Depending on the size and location of the diseased vein, a specific concentration and volume of sclerosant is required. For this reason visible veins are treated using micro-sclerotherapy (MSc) because the diseased vessels can be directly visualised.
Diseased truncal vessels which are not readily visible require the use of ultrasound-guided sclerotherapy (UGS). In this treatment, ultrasound is used to identify the diseased vessel and guide the needle into the vessel for the purpose of injecting sclerosant.
3. Is sclerotherapy a painful procedure?
No. Sclerotherapy is generally very well tolerated. Even patients with a fear or phobia of needles have been treated with minimal fuss.
Ultrasound-guided sclerotherapy involves as many as 5-10 injections. The needle used is finer than that used to take a routine blood test. Often there is no further sensation after the injection.
Micro-sclerotherapy may involve up to 20 to 30 injections in a single treatment session. The type of needle used for this technique is the similar in size to that used for acupuncture.
4. What is trapped blood and how does it occur?
Trapped blood occurs in approximately 1 in 3 patients who receive any form of sclerotherapy. It has been mentioned earlier that sclerotherapy causes shrinkage and closure of diseased veins. Often there are sections of incompletely treated veins between segments of completely treated veins. This trapped blood causes noticeable bruising and small segments of lumpy, tender veins but does not usually occur until 2 to 4weeks after the treatment session. To prevent pigmentation, it is important to release all occurrences of trapped blood. This is done with a needle prick and requires no other special care or attention.
Diagram of an incompletely treated vessel
5. Can sclerotherapy be unsafe?
Patients who are either immobile or unable to wear grade 2 compressive stockings are not suitable for sclerotherapy. Also patients with a strong history of deep-vein thrombosis (DVT) or blood clotting disorder must be treated with extreme caution.
DVT risk factors can be readily identified with the Personal Profile©. The risk of DVT per sclerotherapy treatment has been reported in the scientific literature as ranging from 1 in 500 to 1 in 1000. In simple terms, the risk of DVT with sclerotherapy treatment is approximately equivalent to the DVT risk associated with flying long distances, taking hormone tablets or smoking heavily. Remember also that untreated varicose veins are a risk on their own. Early detection and prompt treatment remain the best option for managing this complication.
In patients with no additional risk factor, sclerotherapy is a very safe treatment option.
6. Will abnormal veins keep coming back?
Generally, veins treated adequately by sclerotherapy do not recur.
It is more important, however, to understand that the underlying weakness in the vein walls is not corrected by sclerotherapy and therefore new vessels will be expected to appear with time.
It is important to maintain normal body weight, exercise regularly and avoid wearing high-heeled shoes to minimise the development of dilated veins.
An annual check-up is recommended to detect the development of new veins earlier. These can then be treated far more readily. Future sclerotherapy treatments should be expected in most cases
7. Can sclerotherapy be undergone if pregnant or breast-feeding?
Sclerotherapy should not be performed on patients who are pregnant or intending to become pregnant. The same rule applies to mothers who are breast feeding. There is no current data available on the effect of using sclerosants during pregnancy or breast feeding.
If planning a pregnancy, undergoing sclerotherapy treatment well in advance of becoming pregnant is advisable as it may assist in reducing the overall disease progression during pregnancy. Unlike surgical stripping, new varicose veins that may appear following pregnancy can be quite easily managed with sclerotherapy.
8. How long does the procedure take?
Sclerotherapy procedures are remarkably painless and do not involve long procedures or hospital stays.
The micro-sclerotherapy procedure is performed in the treatment room and takes approximately 1 hour for the entire process. This includes set-up, pack-up, application of stockings etc. The ultrasound-guided sclerotherapy procedure takes approximately the same amount of time but is performed in the vascular laboratory at the same premises.