Sclerotherapy | Advanced Vein Treatment

What is Sclerotherapy?

Sclerotherapy has been used to eliminate spider veins since the early twentieth century (1). It involves the injection of a sclerosing solution directly into the affected veins. This solution injures the vein wall and causes the vein itself to break down and disperse into the circulation.

Varicose veins and spider veins affect both men and women. In the United States, roughly 9 percent of men and 13 percent of women have varicose veins, and spider veins have been reported in 29 percent of men and 41 percent of women (2). Sclerotherapy can greatly improve the appearance of the affected part of the body and decrease the pain and discomfort associated with these vein conditions.

What is the Difference between Varicose Veins and Spider Veins?

Aging of blood vessels is a major cause of both conditions, but different factors are also involved.

Varicose veins are bulging, bluish, and broken or twisted veins most commonly seen in the legs. The condition is caused by an increase in blood pressure inside the vein, which weakens or damages the vein walls. The condition affects people who walk, stand, or sit for long periods of time, causing pooling of the blood vessels in the legs. Pregnancy can contribute to swollen leg veins (and to spider veins), and these “varicosities” increase with multiple pregnancies. (2) Leg-crossing, obesity, constipation, and other conditions may also cause them.

Spider veins, which doctors refer to as “telangiectasia,” are blood vessels near the surface of the skin that appear as spidery pink or red lines. Sometimes these lines can cluster to form a reddish patch on the skin; this is called “matting.” Spider veins are associated with varicose veins, but they are also a feature of autoimmune diseases that affect the skin and other connective tissues. Fair-skinned people may develop spider veins in areas of sun-damaged skin.

What Can I Expect During Sclerotherapy?

Sclerotherapy is an out-patient procedure performed in the doctor’s office by a dermatologist or surgeon. Depending on which veins are affected, your doctor may have you sit or lie down with your legs slightly elevated. After cleansing the area with alcohol, the doctor will then use a syringe with a fine needle to slowly inject the solution into the vein(s). After removing the needle, the doctor will apply compression to the injection site with cotton and tape. (2) The doctor may also massage the area to ensure the solution disperses well throughout the vein. You will be able to move freely and walk around afterward.

How Effective is Sclerotherapy?

As reported in several studies, when properly done, sclerotherapy can be successful in resolving 90 percent or more of treated vessels. It is very important to be examined before this procedure; Some vessels are poor candidates for sclerotherapy and would be better treated with surgery or with different laser treatments. If a vein is a good candidate for sclerotherapy, it is often cheaper and safer than surgery or laser treatments. Sclerotherapy for treatment of spider veins is especially effective, with success rates of 80-90 percent (1).

Does Sclerotherapy Hurt?

Some discomfort can be expected. Some patients experience cramping in the leg and, depending on the solution used, there may be a stinging or burning sensation when it enters the vein. Your doctor may encourage massage to the area to ease the cramping during this process.

Is Sclerotherapy Safe?

Complications from sclerotherapy are rare, and overall it is a safe and well-tolerated procedure. The most often local adverse effects of sclerotherapy are bruising, temporary swelling and crusting at the site of injection, hyperpigmentation (discoloration of the skin), and matting (2, 3). An allergic reaction to the solution used is also possible, especially for those with a history of allergies.

Reported adverse reactions have been attributed to the sclerosing solutions used. There are three kinds of these solutions: detergents, chemical irritants, and osmotic agents (the last being solutions that can pass through the membrane into a solution where the concentration is higher) (3). Your doctor will determine which solution is appropriate.

Moreover, there is greater risk of complications in treating larger veins; as the size of the blood vessel increases, the amount and strength of the sclerosing solution must also increase. (1)

Serious systemic effects in some patients include stroke and mini-stroke, visual disturbances, and heart attack, but the frequency of these events is difficult to estimate (3).

Who Should Not Have Sclerotherapy?

In patients with certain health conditions, sclerotherapy is not advised; such conditions include pregnancy, infection, blood clots in the vein (venous thrombosis/deep vein thrombosis), allergic sensitivity to the solution, and arterial disease). (1)

Moreover, patients with systemic disease may not be good candidates for sclerotherapy because of poor healing and risk of infection. Systemic conditions that can rule out sclerotherapy include poorly controlled hypertension, congestive heart failure, diabetes, asthma, and infectious diseases. (2)

Sclerotherapy may also be problematic for patients who have a history of easy bruising or bleeding and for patients taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or vitamin E therapy, due to increased chances of bruising and bleeding. (2)

It is important to inform your doctor of your medical history and to discuss any concerns about safety during the initial consultation.

What Happens After Sclerotherapy?

After the procedure, compression of the treated veins is essential to help with the healing process. For veins in the legs, following removal of the needle, the doctor will either apply a stretch bandage (such as an Ace bandage) to the treated area and/or prescribe the use of a compression hose. The hose (or bandage) should be worn continuously for at least 24 hours after injection and whenever out of bed for the following 10-14 days. At minimum, patients are advised to use the bandage or compression hose for 3 days (1).

Normal activities can be resumed with the exception of heavy lifting or exertion. A follow-up visit is generally scheduled 1-2 weeks after the procedure. If additional veins need to be treated, they can be done at this time. However, retreatment of any single area should be delayed for 6-8 weeks to allow the veins to completely heal. (1)

How Long Does It Take to See the Results of Sclerotherapy?

In general, spider veins respond in 3-6 weeks, and larger veins respond in 3-4 months. If the veins respond to the treatment, they will not reappear. However, new veins may appear at the same rate as before, so you may need to return for further injections. Note that individual results will depend on the size and number of vessels being treated and also on the patient’s willingness to comply with the instructions regarding use of compression bandages/hose and limits on exertion. (1)

Can I Fly After Sclerotherapy?

Whether you should travel by plane after sclerotherapy depends on several factors: 1) how soon after the treatment you fly, 2) the length of the flight, 3) if your treatment was for superficial or deep veins, 4) your individual risk factors, and 5) the preventative measures you take while in flight. In general you should not fly before the follow-up visit. It is best to discuss your specific situation with your doctor before making travel plans.

How Much Does Sclerotherapy Cost?

The cost of sclerotherapy depends on many factors, including 1) the extent of care necessary, 2) the provider you choose, 3) the type and amount of sclerosing solution used, 4) the number of injections, 5) how the procedure is charged (by injection or by full treatment), and 6) the follow-up needed. During your initial consultation, you will have the opportunity to discuss your individual needs and goals for therapy. Cost generally falls between $400 and $700.

Does Insurance Cover Sclerotherapy?

Because varicose veins and spider veins are superficial, sclerotherapy for these conditions are usually considered a cosmetic procedure rather than a medical necessity and, thus, will not be covered by insurance. The staff at Saguaro Dermatology will be happy to explain billing for the procedure and to discuss all your options before scheduling.

Final Word on Sclerotherapy

The benefits of sclerotherapy are many and the risks few. Sclerotherapy can greatly improve the cosmetic appearance of the veins and ease the pain, burning, cramps, and “restless leg” syndrome that many patients describe. With the recent expansion of Saguaro Dermatology to our Mesa office, we are pleased to offer the services of an experienced dermatologic surgeon who can perform sclerotherapy. If you are looking for spider vein or varicose vein treatment in Phoenix or Mesa Arizona, talk to one of our friendly staff members at Saguaro Dermatology today.

Sources and Suggested Readings

1. Worthington-Kirsch R. Injection sclerotherapy. Semin Intervent Radiol 2005 Sep;22(3):209-217 Accessed June 15, 2021 at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036277/

2. Parsons ME. Sclerotherapy basics. Dermatol Clin 2004;22:501-508

3. Yiannakopoulou E. Safety concerns for sclerotherapy of telangiectases, reticular and varicose veins. Pharmacology 2016:98:62-69

WebMD. Sclerotherapy for Varicose and Spider Veins.
https://www.webmd.com/skin-problems-and-treatments/cosmetic-procedures-sclerotherapy

WebMD: Spider Veins and Varicose Veins.
https://www.webmd.com/skin-problems-and-treatments/spider-and-varicose-veins

NIH (National Institute of Health): Varicose Veins.
https://www.nhlbi.nih.gov/health-topics/varicose-veins

HSS (Hospital for Special Surgery) Telangiectasia and Autoimmune Disease. <b”>https://www.hss.edu/conditions_telangiectasia-and-autoimmune-disease.asp#Causes

Vein Health: Can You Travel after Varicose Vein Treatment.
https://www.veinhealth.com.au/can-you-travel-after-varicose-vein-treatment/

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About Saguaro Dermatology

Our comprehensive dermatology clinic is dedicated to providing you with the highest quality of care, innovative practices, helpful resources and state-of-the-art technology to prevent and treat a multitude of skin disorders. Led by Carsten R. Hamann, MD, PhD, Dathan Hamann, MD, FAAD, Michael McBride, DO, Millard Thaler, MD, Mohs Surgeon and Jenna Wald, MD, Mohs Surgeon, our passionate team looks forward to serving you with respect and compassion.

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