Sclerotherapy as treatment for Varicose and Spider Veins

| In Articles | 4th July 2020

varicose and spider veins

Sclerotherapy (from Greek “skleros” meaning hard) is a non-surgical treatment procedure, minimally invasive, which treats vascular dilatations of the "spider veins" or reticular veins, smaller varicose veins with a diameter up to 3-5 mm. These are visible superficial vessels located immediately under the skin, red, blue, purple, which are formed especially on the thighs, legs and ankles. It is a procedure that treats the visible vessels existing at a given time. Sclerotherapy has no prophylactic effect to prevent the occurrence of other vascular dilatations and has no therapeutic effect on the deep venous system. Spider and varicose veins can be a result of long standing (because of the occupation), hereditary, or because of other illnesses like diabetes.

Sclerotherapy Procedure

The treatment procedure consists in injecting a sclerosing substance, with an irritating effect on the vascular wall, causing an inflammatory reaction that eventually leads to fibrosis and permanent obliteration of the vessel.

Its many advantages and namely, the minimal pain, the rapid recovery of mobility after the procedure, the short duration, the low risk of nerve damage, low bruising and low cost always lead you to consider this method and ask your doctor about it.

After deciding to undergo sclerotherapy, the patient must be aware of the possibilities and limitations of this treatment method, as well as its drawbacks. Before the procedure, the doctor presents all the necessary information in this regard. Injections are most often made in several stages and with progressive amounts and concentrations of the substance. The maneuvers are slightly painful when the needle penetrates, but the injection itself is not perceived as pain. Immediately after the injection there are signs of local inflammation or mild bruising that will pass in 6-8 days. To maintains the result of the treatment, it is recommended to wear a compressive dressing for a few days.

Sclerotherapy has been used for more than 150 years, but, more recently, a modern technique with mousse (foam) has spread, which can possibly be eco-guided and which finds the best application in the treatment of inguinal recurrences (cavernoma of the cross), varicosis of the small saphenous vein and in the obliteration of the reflecting perforating veins.

Foam Sclerotherapy for varicose veins

The development of foam sclerotherapy allows to obtain a greater effect by virtue of the fact that the density of the foam removes the blood better and exposes the inside of the vessel to the most intimate and lasting contact with the chosen chemical. This technological progress has made a further important contribution in recent years to improve the results of sclerotherapy: transillumination. With a small light instrument it is possible to identify the varicose veins, generally the reticular ones, very superficial and small, normally invisible to the naked eye with traditional lighting and not recognizable with other instruments.

Compression stockings

Usually after the sclerotherapy session compressive, elastic stockings or bandages are applied. Compressive stockings have the purpose to increase compression (especially if eccentric compressions such as gauze or cotton wool pads are associated) and to reduce both pain and the formation of hematomas (collection of blood) and excessive venous hardening. The feeling of constriction that the sock entails can be alleviated by walking. The sock or bandage can be freely removed by the patient only in some cases:

  • if a swelling that does not regress with bed rest appears,
  • if they cause pain,
  • if the foot becomes persistently dark or very pale,
  • if intense itching appears.

If circulation is affected by another health problem, such as peripheral neuropathy, that may damage the nerves of the legs, a person might not wear stockings for long and it would be better to contact a doctor.

Once the bandage has been removed, it is advisable to notify the attending physician. The duration of the use of the sock varies from 2 to 3 weeks. It can be removed overnight after the first 48 hours.

Many sclerotherapy sessions may be necessary for each venous region: depending on the type and number of veins to be treated, numerous injections can be performed for each session.

The duration of treatment depends on the extent of the problem, the number of veins to be treated and individual sensitivity to the solution. It should not be forgotten that, in any case, the special substance is injected into a vein or into a lymph vessel and that therefore there is a safety limit dose.

After a session of sclerotherapy you can immediately return to your activities. The procedure, performed in the doctor's office, usually is not painful. After sclerotherapy for varicose veins, bruising or pigmentation may remain. The bruises disappear within 1-2 weeks, the pigmentations, although they almost always disappear, can however remain visible for many months. In this sense, the "lightening" products, especially if used early are very effective. Scarring or other complications are very rare, the most important is the allergic reaction. During the treatment, especially when treating large varicose veins, it is possible that small cords or more or less painful nodules may form. They generally disappear slowly with the use of suitable creams or gels. In the most stubborn cases, the technique involves draining the clot trapped inside the vessel with a small needle and local compression for a few hours: the benefit is almost instantaneous and the lump disappears very quickly without leaving a trace.

A true inflammatory process that is identified in a shallow micro flebite usually painful and accompanied by a more or less extensive redness can happen very rarely. Even in these cases one should not be afraid or dramatized, it is necessary to continue with the elastic stockings and start a therapy with low molecular heparin, antibiotics, systemic and topical anti-inflammatory drugs for 7-10 days and the phenomenon is reduced until it disappears completely.

Sclerosing treatments for varicose veins and capillaries of the legs are normally performed not in summer, in order to avoid that the action of the sun's rays can create skin pigmentations and that vasodilation (dilatation of blood vessels) due to heat complicates the effect of the therapy.

Sclerotherapy is usually performed in the cold period, this not so much for the absence of vein dilatation due to heat, but to prevent UV rays, directly affecting the sclerosed part, from creating pigmentations of the skin that are difficult to remove. However, it is a good practice to avoid undergoing sclerotherapy as treatment for varicose veins in the very hot months (July-August).