Sclerotherapy - varicose and spider veins

Sclerotherapy is a treatment that involves injecting a solution into unwanted varicose or spider veins. These veins may appear on the legs or may be hidden under the skin and fat. The unwanted blood vessels are red or bluish in colour and are a common problem, particularly for women. Some small varicose veins are raised above the skin's surface and may cause aching.

Sclerotherapy is not just a cosmetic procedure. Varicose vein disease can cause many health problems such as blood clots, venous eczema, skin breakdown and ulceration and, rarely, skin cancers.

Causes of varicose and spider veins

The cause of varicose and spider veins is not known. However, in many cases, they run in families. Women seem to develop this problem more often than men. Changes in oestrogen levels in the blood may have a role in the development of varicose veins. Such hormonal changes occur during puberty, pregnancy, breastfeeding and menopause.

The contraceptive or hormone replacement pill have not been shown to significantly increase the risk of developing varicose veins. Other factors that may contribute include:

• Standing or sitting for long periods
• Being immobile for long periods – for example, being confined to bed
• Lack of exercise
• Obesity.

How sclerotherapy works

The solution used to treat unwanted veins is called a sclerosant. When injected into the vein, the sclerosant irritates the blood vessel and causes it to shrivel up and gradually fade. Leg veins clear slowly after sclerotherapy and may take up to two to six months to resolve, depending on vessel size.

Each vein may require several injections, given some weeks apart. Multiple veins can be injected in one treatment session. Allergic reactions to the sclerosants are very rare.

Ultrasound guided sclerotherapy

Ultrasound enables clear visualisation of veins (both normal and abnormal) underneath the skin. Ultrasound-guided sclerotherapy (UGS) uses ultrasound to locate hidden varicose veins in order to accurately treat them.

UGS is best for people with:

• Varicose veins
• Spider veins not responsive to standard injections
• Leg ulcers
• Other complications of varicose veins such as pigmentation and eczema.

Pain and the procedure

A fine needle is used for injecting that is well tolerated (mild pinprick sensation only). Some individuals may experience a burning sensation post-injection that disappears after a few seconds.

After the procedure

To improve the blood circulation in the deep veins, it is essential to walk after the treatment. A compression stocking is worn to reduce the risk of bruising and swelling, and other complications such as inflammation and clots. Regular exercise, weight control and the use of support stockings (if practical) are recommended between treatments and after treatment.

Possible side effects

Possible side effects of sclerotherapy include:

• Bruising – usually at the site of the injection. This will disappear in a few weeks.
• Brown lines or spots – these may appear on the skin at the site of the injected blood vessels. This can occur when blood escapes from the treated vein into the skin. In most cases, this discoloration will disappear in time. In a small number of people (less than five per cent), the brown lines may last up to a year or longer. It is advisable not to take iron supplements while receiving sclerotherapy, as brown lines are caused by the iron content of the red blood cells. Laser therapy can treat stubborn lines or spots, although this treatment cannot be guaranteed to work.
• Lumps – may occur in larger injected veins. These are called ‘trapped blood’ and are not dangerous. They will either be removed a few weeks after the injection or will clear by themselves.
• Swelling – may occur in people who have had large veins treated. To prevent swelling, it is best to wear compression stockings after the treatment.
• Matting – a network of fine blood vessels can develop after sclerotherapy. This can be due to a number of reasons including lack of compression, inadequate compression, hormonal supplements, vitamin E supplements, use of anti-bruising creams or creams containing vitamin E, and inadequate treatment of underlying veins. Matting may resolve spontaneously but it may take a year or longer. It can also be treated using special injection techniques.
• Ulcers – these may form at the site of the injection. They can occur immediately after injection or a few days later. They are rare, but can be quite painful and usually leave scars after they heal.
• Inflammation (phlebitis) and blood clots – phlebitis and blood clotting can affect the treated large veins. It can be caused by a number of factors.

Possible causes of inflammation

Inflammation (phlebitis) and blood clots can be caused if:

• No compression has been applied.
• The applied compression has not been enough.
• You are on the contraceptive pill or hormone replacement therapy.
• There is an underlying tendency to clotting.
• The treatment has been performed just after long distance travel or a major operation.
• The underlying source of leakage in the vein has not been treated adequately.
• The inflammation extends to the deep veins, causing deep vein thrombosis (DVT). DVT is a rare but serious complication of sclerotherapy. It can extend to the lungs, causing pulmonary embolism (clots in the lungs) and even death.
• It is recommended that women stop all hormonal supplements before sclerotherapy (check with your doctor).

Minimising the risk of varicose and spider veins

The following suggestions may help to prevent varicose and spider veins:

• Wear support stockings.
• Maintain good weight control.
• Get regular exercise.
• Avoid wearing high heels, as they affect the proper functioning of the larger veins.

Where to get help

• Your doctor
• Dermatologist
• Australasian College of Dermatologists Tel. (02) 9879 6177

Things to remember

• Sclerotherapy is the injection of a solution into varicose or spider veins.
• Most people can expect an improvement in the appearance of treated veins.
• Side effects of sclerotherapy may include bruising, swelling or brown lines or spots.

You might also be interested in:

• Circulatory system.
  
• Haemorrhoids.
  

Want to know more?

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Last reviewed: August 2012

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Sclerotherapy involves injecting a solution into defective veins. These veins may appear on the legs or may be hidden. The blood vessels are red or bluish in colour and are a common problem, particularly for women. Sclerotherapy is not just a cosmetic procedure as vein disease can cause many health problems.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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