Sclerotherapy

Sclerotherapy is a medical procedure used to treat patients with varicose veins and spider veins. During sclerotherapy, the physician injects a solution directly into the affected vein. The solution irritates the lining of the vessel, causing it to swell and stick together. Over time, the vessel turns into scar tissue that fades from view.

Sclerotherapy is a well-proven procedure and has been used since the 1930s.

Sclerotherapy is performed in a doctor's office. The treatment area is washed.

The solution is injected directly into the vein, using very fine needles. The number of veins injected in one session depends on the size and location of the veins, and your overall medical condition.

Sclerotherapy works well for most patients. Each treatment session is successful for as many as 50 to 80% of the injected veins. Less than 10% of patients who have sclerotherapy do not respond to the injections at all. In these cases, different solutions or a different treatment method, such as laser therapy, may be tried.

In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months. If the veins respond to the treatment, they usually do not return. However, new veins may appear over time. If needed, you may return for injections.

Before the procedure, you will meet with a vascular specialist to see if you are a good candidate for sclerotherapy.

You cannot have sclerotherapy if you are pregnant, breastfeeding or can't get out of bed. If you are pregnant, you need to wait at least three months after delivery before you can be considered for this procedure. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your doctor will consider your personal history, including the cause of the clot and where it occurred, to determine your eligibility.

Sclerotherapy is generally not used on veins that may potentially be used in future surgical bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery) unless it is already considered unusable.

Medications: Before your procedure, please follow these medication guidelines:

• Do not stop taking any medication without first talking to your doctor.
• Tetracycline or Minocin, both antibiotics, may cause staining of your skin if you take them 7 to 10 days before or after sclerotherapy. If you need to take one of these medications, ask your doctor about other antibiotics you can take instead, or about how to safely stop taking these medications. If you need to take an antibiotic before any invasive procedure, such as dental procedures, colonoscopy or surgery, please tell your doctor.
• Do not take aspirin, ibuprofen (such as Motrin or Advil) or other anti-inflammatory medications for 48 hours before and after sclerotherapy. These medications may keep the solution used in sclerotherapy from working properly and can also increase bleeding. You may take Panadol.
• Prednisone keeps the sclerotherapy solution from working properly. If you take prednisone, ask the doctor who prescribed it if you can safely stop taking it for 48 hours before your sclerotherapy procedure.

Other guidelines before the procedure

• DO NOT put lotion on your legs before or after your procedure.
• We recommend that you bring a pair of shorts to wear during your procedure.
• If you have compression hosiery (support stockings) from previous treatments, please bring them with you.

How will I feel?

You may have mild discomfort when the veins are injected. You may feel cramping for 1 to 2 minutes when larger veins are injected.

The sclerotherapy procedure takes about 30 to 45 minutes.

Side effects of sclerotherapy may include:

• Larger injected veins may become lumpy or hard for several months before they clear up.
• You may have raised, red areas where the needles were injected. These should disappear within a few days.
• You may notice brown lines or spots on your skin where the needles were injected. This is possibly caused by a form of iron that escapes from the blood in the injected veins. In most cases, these marks disappear within 3 to 6 months, but there is a small chance (about 5%) that they can be permanent.
• You may have bruising in the areas the needles were injected. This can last several days or weeks.
• You may develop temporary tiny blood vessels in the treated areas. This is called revascularization, flares, mats, or blushing. They may appear days or weeks after the procedure but should fade within a few months. They usually don't require treatment.
• You may have an allergic reaction to the solution used during treatment. This is not usually serious. Symptoms include itching and swelling.

Rare side effects you should tell your doctor about right away include:

• Inflammation within five inches of the groin
• Sudden swelling in your leg
• Small ulcers (open wounds) at the injection site
• Red streaks, especially in the groin area

What happens after my treatment?

You will be able to drive yourself home after your procedure. It is important to walk, and you will be able to go back to your regular activities.

You will need to wear support hosiery or compression wraps to keep the treated veins squeezed into place. You can buy these stockings at any Cleveland Clinic pharmacy.

Support stockings sold at other stores may not offer the right amount of pressure, depending on the strength of the stockings your doctor prescribes.

Wash the injection sites with a mild soap and lukewarm water.

• Do not apply hot compresses or any form of heat to the injected areas.
• Avoid direct exposure to sunlight (including sun tanning and tanning beds).

Call your doctor if you have any concerns or questions after the procedure.