Questions and Answers

What is Sclerotherapy?

Sclerotherapy is a treatment of spider and varicose veins that involves the injection of a solution into a vein, which irritates the inside of the vessel wall, causing it to collapse and completely disappear. This procedure has been used to treat spider veins since the 1930’s and before that for larger vessels.


Does Sclerotherapy work for everyone?

The majority of persons who have sclerotherapy will be cleared of their varicosities; or at least see a 50-90% improvement. In very rare instances, a patient’s condition may become worse after sclerotherapy treatment, and develop a group of fine red blood vessels near the injection site of a larger vessel. However, even in those cases, 90% of those veins will disappear on their own, and some will go away with additional treatments.


Are there other treatment methods?

There are no other methods that are nearly as effective as sclerotherapy. Laser treatment is only effective for small veins on the face and occasionally for fine red blood vessels on the legs. We have a laser in the office which we choose to use on a very rare occasion.


How many treatments will I need?

The number of treatments needed to clear or improve the condition differs from patient to patient. The two main determining factors are the extent of varicose and spider veins present and how each person individually responds to treatment. Typically, an area of veins needs to be reinjected 2-3 times in order for the vein to collapse. Most patients come in for treatment every 1-3 weeks.


How do I prepare for my sclerotherapy session?

We recommend that you wear loose fitting pants and avoid applying moisturizing creams to your legs on the day of your visit. It is not an issue if you are bruised or tan.


What should I expect during a sclerotherapy treatment?

After your initial consultation, your treatment will begin. First your legs are cleaned with rubbing alcohol. Then with sterile disposable tiny needles we start to do the injections. Some patients experience an occasional slight burning sensation during the injections. When we finish doing the injections your legs will be cleaned off again and hydrocortisone cream will be applied to the area of treatment. This cream helps diminish any itching sensation and also helps decrease swelling and pain. Finally, your legs will be wrapped with ace-wraps to immediately help compress the veins so that they will disappear as quickly as possible.


What do I need to do after my sclerotherapy session?

At the end of your treatment the area on your legs that was treated will be wrapped with an ace-wrap. You will need to wear the ace-wrap for at least four hours, and maximally until bedtime. After you remove the ace-wrap you will put on a graduated compression stocking, supplied in our office, and will sleep in it only for the first night. You will then wear it for the next two days, but remove it at bedtime.

It is recommended that you do not swim for the first 48 hours or to enter a sauna or hot tub. Otherwise there is no restricted activity. In fact, we encourage walking. It is also recommended that, while sitting, you keep your legs elevated as much as possible.


What are the side effects of sclerotherapy?

Bruises and red raised bumps at the injection site

Depending on how you heal, these bruises and bumps will completely go away in 5-14 days.

Itching

You may experience mild itching along the vein route. This itching can occur immediately after treatment and can be intermittent for 1-2 days.

Pain

Few patients experience any pain after treatment. At times, the bruises or swelling can be tender to the touch. However, this all resolves in a few days.

Hyperpigmentation

A low percentage of patients, more commonly with people with darker skin tones, might notice a discoloration of light brown markings where the veins once were. This pigmentation typically resolves within a few months. We also prescribe bleaching creams when necessary to help diminish these marks.

Ulceration

These are extremely rare and occur 1/10-15,000 injections. They are typically less than a centimeter in size and look like a cigarette burn. They can occur when some of the solution escapes into the surrounding skin or enters a tiny artery at the treatment site. These can be successfully treated.

Allergic Reactions

As with any medication, one can be allergic to the sclerosing agent. Severe reactions are extremely rare, but do need to be treated immediately.

Recovery

After instructions for the sclerotherapy patient:

Congratulations! You’ve taken your first steps in getting rid of those unwanted veins! The rest is easy!

If your legs have been wrapped with an ace-bandage keep the bandage on for minimally four hours or until bedtime. When you remove the ace-wrap you should also remove any cotton balls, cream or tape. If you still have any areas that are itchy, you can put on a small amount of hydrocortisone cream 0.5% to help relieve those symptoms.

After removing the ace-wrap, you should then put on your compression stockings. It is highly recommended for you to sleep in the compression stockings the first night after your treatment. You should then wear the compression stockings for the next two days- during the day only. You do not need to sleep in the stockings except for the first night.

You can’t wear the stockings too much. Most people initially find the stockings somewhat tight and uncomfortable. However, after a few days, the stockings usually loosen up and form to your figure. Feel free to wear your compression stockings everyday if you want to. Many patients actually find that their legs have a lot more energy and much less heaviness when wearing the support hose.


 
 

Frequently asked Questions and Answers

Can I just sleep in the ace-wraps instead of the stockings?

No. We do not recommend for you to sleep with the ace-wrap. Ace-wraps have a tendency to roll and can cause a tourniquet-like effect. They also don’t give an equal graduated compression like the stockings.


Why do I have to wear the stockings?

The greatest effects of the sclerotherapy happen within the first 48 hours after treatment. The stockings make an enormous difference in helping the veins close down quickly and evenly.


What are the restrictions following treatment?

There really are no absolute restrictions. However, it is not highly recommended to take very hot showers or go into a hot tub. This is because heat causes veins to dilate- get larger, and we’re trying to make them smaller.


After treatment is it o.k. for me to exercise? To go on an airplane?

Yes. You absolutely can exercise. However, it is not recommended to wear the support stockings while exercising. Just take them off while exercising and put them back on when you’re finished. And yes, you can fly too! Just remember to wear your stockings.


When should I come back for my next appointment?

It is recommended to come back every week until you’re treatments are completed. However, as most of us can have hectic schedules, it is also o.k. to extend your visits for up to every 2-3 weeks.


What side effects should I expect?

Most every patient will have bruising- and sometimes the bruises can be quite large. This is absolutely normal. It is also normal to experience some swelling, itching, redness and sometimes tenderness to the area treated. All of these are normal as well and should all subside in roughly 7-10 days after treatment. You can take Tylenol 1 gram every four hours as needed for pain and/or apply cold compresses to the area of discomfort.


What things should I be concerned about?

As with any procedure, infection is the number one concern. Although extremely rare, and in fact, has never occurred to any of our patients, it can happen. If you develop a fever, red streaks going up your leg, pustulent drainage or severe pain, please call our office so that we can discuss your symptoms. If you do have an infection it can easily be treated with an oral antibiotic which we would be happy to call into your regular pharmacy.